adorable baby smiling with joy

Peds Calc

Back to Cefixime Overview

Cefixime Indications & Clinical Uses

Evidence-based guide for pediatric prescribing

Cefixime is an oral third-generation cephalosporin reserved for upper respiratory infections and UTIs when first-line therapies fail or cannot be used.

Primary FDA-Approved Indications

Use cefixime when beta-lactamase coverage is required and adherence benefits from once-daily dosing. Culture guidance and local resistance patterns should drive selection.

Acute otitis media

FDA Approved
Children ≥6 monthsModerate

Use when amoxicillin/clavulanate is not tolerated or nasopharyngeal beta-lactamase producers are likely.

Acute bacterial rhinosinusitis

FDA Approved
Children and adolescentsModerate

Reserve for penicillin allergy (non-IgE) or after amoxicillin/clavulanate failure.

Group A streptococcal pharyngitis

FDA Approved
Children and adolescentsModerate

Only when penicillin or amoxicillin cannot be used; ensure negative immediate penicillin allergy history to reduce cross-reactivity concerns.

Secondary Clinical Uses

Uncomplicated urinary tract infection (culture-directed)

Secondary Use
Children ≥6 monthsLow

Not first-line; prefer nitrofurantoin or TMP-SMX when susceptible.

Off-Label Uses

Note: Off-label uses may be clinically appropriate based on evidence and expert consensus, but are not FDA-approved for these indications. Always consider the evidence base and document clinical reasoning.

Gonococcal urethritis/cervicitis (adolescents)

Off-Label
Adolescents

500 mg PO once plus azithromycin per CDC guidance when ceftriaxone unavailable; requires public health consultation.

•Evidence quality: 80/10
Back to Overview