Cefixime is a third generation semisynthetic cephalosporin antibiotic. Cephalosporins are derivatives of 7-aminocephalosporicacid and are closely related to penicillin in structure. Cephalosporins have a six membered sulfur containing ring adjoining a ß lactam ring. Cefixime is effective in a large variety of bacterial infections, such as respiratory tract, ear, skin, gonorrhea, otitis media, and urinary tract infections. Administered orally. Antibiotics require constant drug level in body for therapeutic effect. This is achieved by taking the medication at regular interval of time throughout the day and night prescribed. Cefixime is important to take the drug for the full time period as prescribed. If you discontinue the therapy, it may result in ineffective treatment.
Mechanism of Action
Cefixime has marked in vitro bactericidal activity of gram positive and gram negative. Like other cephalosporins, Cefixime exhibits its bactericidal action by binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall, causing the inhibition of the third and last stage of bacterial cell wall synthesis. Cell lysis is then mediated by bacterial cell wall autolytic enzymes such.as autolysins. The antibacterial effect of cefixime results from inhibition of mucopeptide synthesis in the bacterial cell wall.
Absorption & Distribution
Cefixime given orally, is about 40%-50% absorbed whether administered with or without food, however, time to maximal absorption is increased approximately 0.8 hours when administered with food. Cefixime is better absorbed from oral suspension than from other oral dosage forms. The plasma half life is usually about 3-4 hours. Cefixime is approximately 65% bound to plasma proteins, independent of drug concentration. Cefixime crosses the placenta.
Metabolism & Excretion
Approximately 50% of an absorbed dose of cefixime is excreted as unchanged drug in the urine in 24 hours. Up to 60% may be eliminated by non-renal mechanism; there is no evidence of metabolism but some is probably excreted into the feces from bile.
Uses
Cefiget (Cefixime) is indicated in the treatment of the following infections when caused by susceptible strains of the designated microorganisms:
- Respiratory Tract Infections
- Infections of the upper and lower airways
- Pulmonary infections of bacterial etiology
- Bronchitis (acute, chronic)
- Pneumonia
- Bronchiectasis with infection
- Secondary infections in chronic respiratory diseases
- Ear, Nose & Throat Infections
- Otitis media
- Sinusitis
- Tonsillitis
- Pharyngitis
- Laryngitis
- Gastrointestinal Infections
- Typhoid
- Urinary Tract Infections
- Infections of the kidneys and efferent urinary tract
- Uncomplicated urinary tract infections
- Complicated and uncomplicated urinary tract infections except for prostatitis
- Pyelonephritis
- uncomplicated pyelonephritis
- Gonococcal urethritis
- Uncomplicated gonorrhea (cervical/urethral)
- Biliary Tract Infections
- Infections of the biliary tract
- Cholecystitis
- Cholangitis
- Scarlet Fever
Side Effects
The severe or irreversible adverse effects of Cefixime, which give rise to further complications include:
- Pseudomembranous colitis
- Thrombocytopenia
- Thrombophlebitis
- Leucopenia
- Seizures
- Vaginitis.
The symptomatic adverse reactions produced by Cefixime are more or less tolerable and if they become severe, they can be treated symptomatically, these include:
- Flatulence
- Dizziness
- Headache
- Nausea
- Vomiting
- Anorexia
- Diarrhea
- Abdominal pain
- Urticaria
- Pruritus
- Dyspepsia
- Hypersensitivity
- Increased intracranial pressure
- Xerostomia
- Pain at injection site.
DOSAGE AND ADMINISTRATION
- Adults & children over 12 years: The recommended adult dosage is 200mg 400mg daily administered either as single dose or in two divided doses. The dosage may be adjusted depending on the patient’s age, body weight, symptoms and renal function, given orally once daily or twice daily.
- Children (Use Pediatric Oral Suspension or DS Suspension): The recommended dosage for children is 8ng/kg/day administered as a single dose. As a general guide for prescribing in children, the following daily doses in terms of volume of Pediatric Oral Suspension or DS Oral Suspension are suggested.
CONTRAINDICATIONS
Cefixime is contraindicated in:
Patients with hypersensitivity to any component of this medication.
Patients with known, allergy to the cephalosporin group of antibiotics Children less than six months old as safety and efficacy of cefixime in these patients have not been established.
DRUG INTERACTIONS
- Anticoagulants: Care should be exercised in patients receiving anticoagulants and cefixime concomitantly due to the the possibility that cefixime may increase prothrombin time.
- Carbamazepine: Elevated carbamazepine levels have been reported when cefixime is administered concomitantly. Drug monitoring may be of assistance in detecting alterations in carbamazepine plasma Concentrations.
- Drug/Laboratory Interactions
- A false-positive reaction for ketones in the urine may occur with tests using nitroprusside but not with those using nitroferricyanide.
- The false-positive reaction for glucose in the urine may occur with Benedict’s or Fehling’s solutions or with copper sulphate test tablets, but not with tests based or enzymatic glucose oxidase reactions.
- A false-positive direct Coombs test has been reported during treatment with cephalosporin antibiotics, therefore it should be recognized that a positive Coombs test may be due to the drug.
OVERDOSAGE
There have been limited clinical experiences with overdose of cefixime
to date. No specific antidote exists, General supportive measures are
recommended.
WARNING
Drug should not be given to Pediatrics, Pregnant Mothers, and patients suffering from Kidney dysfunction. If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
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