Drugs List

Therapeutic Indications

Uses

Acute lower respiratory tract infections - treatment
Acute upper respiratory tract infections - treatment
Acute urinary tract infections - treatment

Unlicensed Uses

Uncomplicated gonorrhoea

Contraindications

Children under 6 months

Precautions and Warnings

Children under 10 years
Breastfeeding
Pregnancy
Renal impairment - creatinine clearance below 20ml/minute

Dialysis patients may require dose reduction
Reduce dose in patients with creatinine clearance below 20ml/min
Before initiating therapy enquire about previous hypersensitivity reactions
Consult national/regional policy on the use of anti-infectives
Not all formulations are suitable for all age groups/body weights
Assess renal function prior to prescribing in the elderly
Monitor renal function in patients with renal impairment
Advise patient to report diarrhoea
Consider pseudomembranous colitis if patient presents with diarrhoea
Prolonged use may result in superinfection with non-susceptible organisms
Test interference: May cause false positive Coombs test
May cause false positive for glycosuria : Benedict's / Fehling's solution
Discontinue at once if pseudomembranous colitis occurs
Discontinue if drug-related rash or other hypersensitivity reactions occur
Discontinue if renal failure develops

Pregnancy and Lactation

Pregnancy

Use cefixime with caution in pregnancy.

Briggs suggests cefixime is compatible in pregnancy. No detectable teratogenic risk with cephalosporins was found in a large study in 2001. The manufacturer suggests cefixime should not be used in pregnancy unless essential.

At the time of writing, there are limited data available on the use of cefixime in pregnancy. Animal studies have not shown any evidence of teratogenicity.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use cefixime with caution in breastfeeding.

The Drugs and Lactation Database (LactMed) suggests cephalosporins are not expected to cause adverse effects in breastfed infants and considers cefixime as acceptable to use during breastfeeding. The manufacturer suggest cefixime should not be used in breastfeeding unless essential.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Acute renal failure
Agranulocytosis
Alanine aminotransferase increased
Altered liver enzymes values
Altered liver function tests
Anaphylactic shock
Anaphylaxis
Angioneurotic oedema
Anorexia
Antibiotic-associated colitis
Aplastic anaemia
Arthralgia
Aspartate aminotransferase increased
Blood urea increased
Cholestatic jaundice
Confusion
Convulsions
Diarrhoea
Dizziness
Drug fever
Drug rash with eosinophilia and systemic symptoms (DRESS)
Dyspepsia
Dyspnoea
Encephalopathy
Eosinophilia
Erythema multiforme
Facial oedema
False positive Benedict's test (transient)
False positive Coombs test
Flatulence
Genital pruritus
Granulocytopenia
Haemolytic anaemia
Headache
Hepatitis
Hypersensitivity reactions
Impaired consciousness
Increase in blood urea or creatinine
Increases in hepatic enzymes
Interstitial nephritis
Jaundice
Leucopenia
Movement disturbances
Mucosal inflammation
Nausea
Neutropenia
Pancytopenia
Pruritus
Pseudomembranous colitis
Psychomotor excitation
Pyrexia
Rash
Serum bilirubin increased
Serum creatinine increased
Serum sickness
Serum sickness-like reactions
Stevens-Johnson syndrome
Superinfections
Thrombocytopenia
Thrombocytosis
Toxic epidermal necrolysis
Urticaria
Vaginitis
Vertigo
Vomiting

Presentation

Oral formulations of cefixime.

Drugs List

Therapeutic Indications

Uses

Acute lower respiratory tract infections - treatment
Acute upper respiratory tract infections - treatment
Acute urinary tract infections - treatment

Unlicensed Uses

Uncomplicated gonorrhoea

Dosage

Usual course of treatment seven days. May be extended to fourteen days if required.

Adults

Children

Patients with Renal Impairment

Contraindications

Children under 6 months

Precautions and Warnings

Children under 10 years
Breastfeeding
Pregnancy
Renal impairment - creatinine clearance below 20ml/minute

Dialysis patients may require dose reduction
Reduce dose in patients with creatinine clearance below 20ml/min
Before initiating therapy enquire about previous hypersensitivity reactions
Consult national/regional policy on the use of anti-infectives
Not all formulations are suitable for all age groups/body weights
Assess renal function prior to prescribing in the elderly
Monitor renal function in patients with renal impairment
Advise patient to report diarrhoea
Consider pseudomembranous colitis if patient presents with diarrhoea
Prolonged use may result in superinfection with non-susceptible organisms
Test interference: May cause false positive Coombs test
May cause false positive for glycosuria : Benedict's / Fehling's solution
Discontinue at once if pseudomembranous colitis occurs
Discontinue if drug-related rash or other hypersensitivity reactions occur
Discontinue if renal failure develops

Pregnancy and Lactation

Pregnancy

Use cefixime with caution in pregnancy.

Briggs suggests cefixime is compatible in pregnancy. No detectable teratogenic risk with cephalosporins was found in a large study in 2001. The manufacturer suggests cefixime should not be used in pregnancy unless essential.

At the time of writing, there are limited data available on the use of cefixime in pregnancy. Animal studies have not shown any evidence of teratogenicity.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use cefixime with caution in breastfeeding.

The Drugs and Lactation Database (LactMed) suggests cephalosporins are not expected to cause adverse effects in breastfed infants and considers cefixime as acceptable to use during breastfeeding. The manufacturer suggest cefixime should not be used in breastfeeding unless essential.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Acute renal failure
Agranulocytosis
Alanine aminotransferase increased
Altered liver enzymes values
Altered liver function tests
Anaphylactic shock
Anaphylaxis
Angioneurotic oedema
Anorexia
Antibiotic-associated colitis
Aplastic anaemia
Arthralgia
Aspartate aminotransferase increased
Blood urea increased
Cholestatic jaundice
Confusion
Convulsions
Diarrhoea
Dizziness
Drug fever
Drug rash with eosinophilia and systemic symptoms (DRESS)
Dyspepsia
Dyspnoea
Encephalopathy
Eosinophilia
Erythema multiforme
Facial oedema
False positive Benedict's test (transient)
False positive Coombs test
Flatulence
Genital pruritus
Granulocytopenia
Haemolytic anaemia
Headache
Hepatitis
Hypersensitivity reactions
Impaired consciousness
Increase in blood urea or creatinine
Increases in hepatic enzymes
Interstitial nephritis
Jaundice
Leucopenia
Movement disturbances
Mucosal inflammation
Nausea
Neutropenia
Pancytopenia
Pruritus
Pseudomembranous colitis
Psychomotor excitation
Pyrexia
Rash
Serum bilirubin increased
Serum creatinine increased
Serum sickness
Serum sickness-like reactions
Stevens-Johnson syndrome
Superinfections
Thrombocytopenia
Thrombocytosis
Toxic epidermal necrolysis
Urticaria
Vaginitis
Vertigo
Vomiting

Effects on Laboratory Tests

May cause false positive Coombs test.

May cause false positive with Benedict's or Fehling's solutions or with copper sulfate test tablets but not with tests based on enzymatic glucose oxidase reactions.

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: December 2017

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Summary of Product Characteristics: Suprax Tablets 200mg. Sanofi-Aventis. Revised June 2018.

Summary of Product Characteristics: Cefixime Tablets 400mg. Rivopharma. Revised March 2016.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 14 September 2018

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Cefixime. Last revised: 10 March 2015
Last accessed: 20 December 2017