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Cefixime Uses, Dosage, Side Effects & Price | DrugsAtlas

Authoritative Clinical Reference

Therapeutic Class

Antibacterial

Subclass

Third-generation oral cephalosporin

Speciality

Infectious Diseases

Schedule (India)

Schedule H

Routes

Oral

Formulations

Form	Strengths
Tablets	100 mg, 200 mg
Dispersible tablets	100 mg, 200 mg
Oral suspension (dry syrup)	50 mg/5 mL, 100 mg/5 mL

Adult indications

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

1. Typhoid Fever (Enteric Fever — Salmonella Typhi)

Parameter	Details
Starting dose	200 mg orally twice daily OR 400 mg once daily
Titration	Not applicable
Usual maintenance dose	400 mg/day (in single or divided doses)
Maximum dose	400 mg/day
Duration	10–14 days

Clinical Notes:

First-line oral option for uncomplicated typhoid in Indian settings
Culture-guided therapy preferred where feasible
Monitor for clinical response by day 5–7
Watch for relapse 7–14 days after completing therapy
Consider alternatives if fluoroquinolone-resistant or MDR strains prevalent locally

2. Acute Uncomplicated Urinary Tract Infection (Cystitis)

Parameter	Details
Starting dose	200 mg orally twice daily OR 400 mg once daily
Titration	Not applicable
Usual maintenance dose	400 mg/day
Maximum dose	400 mg/day
Duration	5–7 days

Clinical Notes:

Reserve for culture-confirmed susceptible organisms
Increasing resistance among uropathogens in India; not empiric first-line in many centres
Consider nitrofurantoin or fosfomycin as alternatives for uncomplicated cystitis

3. Acute Bacterial Exacerbation of Chronic Bronchitis

Parameter	Details
Starting dose	200 mg orally twice daily OR 400 mg once daily
Titration	Not applicable
Usual maintenance dose	400 mg/day
Maximum dose	400 mg/day
Duration	7–10 days

Clinical Notes:

Obtain sputum culture if recurrent exacerbations
Effective against common respiratory pathogens (H. influenzae, M. catarrhalis, S. pneumoniae)

4. Community-Acquired Pneumonia (Mild to Moderate)

Parameter	Details
Starting dose	200 mg orally twice daily OR 400 mg once daily
Titration	Not applicable
Usual maintenance dose	400 mg/day
Maximum dose	400 mg/day
Duration	7–10 days

Clinical Notes:

Suitable for outpatient management of mild-to-moderate CAP
Consider combination with macrolide if atypical pathogens suspected
Not effective against atypical organisms (Mycoplasma, Chlamydia, Legionella)

5. Acute Pharyngitis / Tonsillitis (Group A Streptococcus)

Parameter	Details
Starting dose	200 mg orally twice daily
Titration	Not applicable
Usual maintenance dose	400 mg/day in divided doses
Maximum dose	400 mg/day
Duration	5–10 days

Clinical Notes:

Second-line agent; penicillin V or amoxicillin remain first-line
Reserve for documented penicillin allergy (non-immediate type)
Full 10-day course recommended to prevent rheumatic fever

6. Acute Otitis Media

Parameter	Details
Starting dose	200 mg orally twice daily OR 400 mg once daily
Titration	Not applicable
Usual maintenance dose	400 mg/day
Maximum dose	400 mg/day
Duration	7–10 days

Clinical Notes:

Second-line option when amoxicillin fails or contraindicated
Assess clinical improvement by day 3–5

Secondary Indications — Adults (Off-label, if any)

Indication	Dose	Duration	Notes
Uncomplicated Gonorrhoea (cervical/urethral/rectal) — OFF-LABEL	400 mg single oral dose	Single dose	Specialist only. Use only when local antimicrobial surveillance confirms susceptibility. High rates of cefixime resistance reported in many Indian cities; injectable ceftriaxone preferred. Evidence: WHO/CDC STI guidelines; limited current use in Indian STI practice due to resistance.

Paediatric indications

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

1. Typhoid Fever (Enteric Fever)

Age: ≥6 months

Parameter	Details
Starting dose	8 mg/kg/day orally in two divided doses
Titration	May increase to 10–20 mg/kg/day based on severity and response
Usual maintenance dose	10–15 mg/kg/day in two divided doses
Maximum dose	400 mg/day
Duration	10–14 days

Clinical Notes:

First-line oral option for uncomplicated paediatric typhoid in India
Culture-guided therapy preferred
Monitor for clinical response; observe for relapse post-treatment
Oral suspension should be reconstituted properly and shaken well before each dose

2. Acute Pharyngitis / Tonsillitis (Penicillin Allergy)

Age: ≥6 months

Parameter	Details
Starting dose	8 mg/kg/day orally in two divided doses
Titration	Not applicable
Usual maintenance dose	8 mg/kg/day in two divided doses
Maximum dose	400 mg/day
Duration	10 days

Clinical Notes:

Second-line for GAS pharyngitis when penicillin contraindicated
Complete 10-day course for rheumatic fever prevention

3. Acute Otitis Media

Age: ≥6 months

Parameter	Details
Starting dose	8 mg/kg/day orally (once daily or in two divided doses)
Titration	Not applicable
Usual maintenance dose	8 mg/kg/day
Maximum dose	400 mg/day
Duration	7–10 days

Clinical Notes:

Assess clinical improvement by day 3–5
May use once-daily dosing for improved compliance

4. Urinary Tract Infection (Paediatric)

Age: ≥6 months

Parameter	Details
Starting dose	8 mg/kg/day orally in two divided doses
Titration	Not applicable
Usual maintenance dose	8 mg/kg/day
Maximum dose	400 mg/day
Duration	7–14 days (depending on upper vs lower UTI)

Clinical Notes:

Culture and sensitivity essential
Consider parenteral therapy for pyelonephritis or toxic-appearing child

Secondary Indications — Paediatrics (Off-label, if any)

Not applicable. No well-documented off-label paediatric indications in Indian practice.

Age Restriction:
Not recommended in infants below 6 months of age except under paediatric infectious diseases specialist supervision with documented clinical necessity.

Safety Monitoring (All Paediatric Patients):

Monitor for diarrhoea, rash, and hypersensitivity reactions
Assess clinical response within 48–72 hours
Reconstitute suspension as per manufacturer instructions; shake well before use
Maintain adequate hydration

Renal Adjustments

eGFR (mL/min)	Dose Adjustment
>60	No adjustment required
21–60	Reduce to 75% of usual daily dose
≤20	Reduce to 50% of usual daily dose

Dialysis Status	Recommendation
Haemodialysis	Give 50% of standard dose after dialysis session
Peritoneal dialysis	Not significantly dialysed; use 50% dose with caution

Hepatic adjustment

Contraindications

Known hypersensitivity to cefixime or any cephalosporin antibiotic
History of immediate-type (Type I) hypersensitivity reaction to penicillins (anaphylaxis, angioedema, urticaria occurring within 1 hour) — cross-reactivity risk approximately 1–2%
Known hypersensitivity to any excipient in the formulation

Cautions

History of non-immediate penicillin allergy — use with caution; monitor closely
History of antibiotic-associated colitis or Clostridioides difficile infection
Renal impairment — dose adjustment required
History of seizure disorder or CNS pathology — cephalosporins may rarely lower seizure threshold
Prolonged use may result in superinfection with resistant organisms or fungi
Monitor for emergence of resistance, especially in recurrent infections

Pregnancy

Parameter	Details
Overall safety	Generally considered safe; limited human data but no evidence of teratogenicity
Risk category	Comparable to FDA former Category B
Preferred alternatives	Amoxicillin or amoxicillin-clavulanate preferred when susceptibility confirmed
When to use	May be used when benefit clearly outweighs risk, particularly for UTI or respiratory infections unresponsive to first-line agents
Monitoring	Maternal renal function; GI tolerance; clinical response

Lactation

Parameter	Details
Compatibility	Compatible with breastfeeding
Milk levels	Very low; minimal excretion into breast milk
Preferred alternatives	Amoxicillin preferred when appropriate
Infant monitoring	Observe for rash, loose stools, oral candidiasis (all rare)

Elderly

Parameter	Recommendation
Starting dose	Same as adult dose (400 mg/day)
Titration	Not applicable
Special considerations	Renal function assessment mandatory — estimate eGFR and adjust dose accordingly. Increased risk of Clostridioides difficile-associated diarrhoea. Monitor hydration status. More susceptible to adverse GI effects.

Major drug interactions

Interacting Drug	Mechanism / Effect	Recommendation
Warfarin	Altered gut flora reduces vitamin K synthesis; potential increase in INR and bleeding risk	Monitor INR closely when initiating or discontinuing cefixime; adjust warfarin dose as needed
Carbamazepine	Cefixime may increase serum carbamazepine levels	Monitor for carbamazepine toxicity (ataxia, nystagmus, drowsiness); consider level monitoring

Moderate drug interactions

Interacting Drug	Effect	Recommendation
Probenecid	Decreases renal tubular secretion of cefixime, increasing serum levels	Clinical monitoring; dose adjustment usually not required
Oral contraceptives	Theoretical reduction in efficacy due to altered gut flora	Counsel regarding backup contraception during antibiotic course (precautionary)
Antacids (aluminium/magnesium-containing)	May slightly reduce cefixime absorption	Administer cefixime 2 hours before or after antacids
Live oral typhoid vaccine (Ty21a)	Antibiotics may reduce vaccine efficacy	Avoid concurrent use; complete antibiotic course at least 3 days before administering live vaccine

Common Adverse effects

Diarrhoea (most common)
Nausea
Abdominal pain / dyspepsia
Flatulence
Headache
Skin rash

Serious Adverse effects

Adverse Effect	Clinical Notes
Anaphylaxis / severe hypersensitivity	Immediate discontinuation required; emergency management with adrenaline
Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN)	Rare; discontinue immediately and hospitalise
Clostridioides difficile-associated diarrhoea (CDAD)	Suspect if persistent or severe diarrhoea develops during or after therapy; discontinue and treat appropriately
Hepatotoxicity	Rare; may present as transaminase elevation; discontinue if significant
Haematological toxicity	Rare; thrombocytopenia, leucopenia, pancytopenia reported — investigate unexplained bleeding or recurrent infections
Seizures	Rare; more likely in patients with pre-existing CNS disorders or renal impairment

Monitoring requirements

Baseline:

Renal function (serum creatinine, eGFR) — especially in elderly or those with comorbidities
Liver function tests if prolonged course anticipated
Allergy history (penicillin, cephalosporin)

After initiation:

Clinical response assessment within 48–72 hours
Monitor for hypersensitivity reactions (rash, urticaria, respiratory distress)
Watch for diarrhoea — especially antibiotic-associated or Clostridioides difficile-related

Long-term (if extended course):

Repeat renal and hepatic function if therapy exceeds 14 days
Monitor for superinfection (oral/vaginal candidiasis)
In typhoid: observe for clinical relapse 7–14 days post-treatment

Brands in India'

Brand Name	Manufacturer
Taxim-O	Alkem
Zifi	FDC Ltd
Mahacef	Mankind
Ceftas	Intas
Cefix	Cipla
Topcef	Lupin
Gramocef-O	Glenmark

Common Fixed-Dose Combinations (FDCs):

Cefixime + Ofloxacin (e.g., Taxim-OF, Zifi-OZ)
Cefixime + Clavulanic acid (e.g., Taxim-CL, Mahacef-CV)
Cefixime + Azithromycin (e.g., Zifi-AZ)

Price range (INR)

Formulation	Approximate Price
Tablet 200 mg (per tablet)	₹7–20
Dispersible tablet 100 mg (per tablet)	₹4–10
Oral suspension 50 mg/5 mL (30 mL bottle)	₹25–50
Oral suspension 100 mg/5 mL (30 mL bottle)	₹40–70

Regulatory status: Cefixime is included in NLEM 2022; ceiling prices regulated by NPPA for scheduled formulations.

Clinical pearls

Typhoid mainstay in India — Cefixime remains a key oral option for uncomplicated typhoid fever in Indian settings, particularly for outpatient management and step-down therapy.
Resistance awareness — Rising resistance among uropathogens and gonococci limits empiric use in UTI and gonorrhoea; always prefer culture-guided therapy when feasible.
Twice-daily dosing may be superior — Although once-daily dosing is convenient, divided dosing (200 mg BD) may provide better pharmacodynamic coverage for certain infections.
Not for serious infections — Cefixime has no activity against Pseudomonas aeruginosa, MRSA, Enterococcus, or ESBL-producing organisms. Do not use for nosocomial or complicated infections.
Monitor for CDAD — Any patient developing persistent diarrhoea during or after cefixime therapy should be evaluated for Clostridioides difficile infection.
FDC caution — Fixed-dose combinations (particularly with fluoroquinolones) should be used judiciously to prevent resistance; monotherapy preferred when organism susceptibility is known.

Version

RxIndia v1.0 — 25 Apr 2025

Reference

- CDSCO approved product inserts (Form 46)
- National Formulary of India (NFI) 2021
- NLEM 2022
- Indian Pharmacopoeia
- API Textbook of Medicine
- ICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019)
- IAP Guidelines — Typhoid and Fever Management
- AIIMS Delhi Antibiotic Formulary (hospital protocol)
- WHO Essential Medicines List (supportive reference for paediatrics)
- CDC/WHO STI Guidelines (supporting off-label gonorrhoea indication)

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This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.

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