29/12/2025
Cefixime
Class: Third-generation cephalosporin (oral).
Mechanism: Bactericidal. Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs). Resistant to many beta-lactamases.
Spectrum: Broad Gram-negative coverage; retained Gram-positive activity.
ยท Gram-negative: Excellent coverage of Haemophilus influenzae, Moraxella catarrhalis, Neisseria gonorrhoeae (including penicillin-resistant strains), Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Salmonella & Shigella spp.
ยท Gram-positive: Covers Streptococcus pneumoniae (but not penicillin-resistant strains) and Streptococcus pyogenes. Not active against Staphylococcus aureus (MSSA or MRSA) or Enterococci.
ยท Gaps: Poor activity against Pseudomonas aeruginosa, anaerobes, and Listeria.
Key Uses:
ยท Uncomplicated gonorrhea (first-line, typically as a single dose with azithromycin for chlamydia coverage).
ยท Acute otitis media and bacterial sinusitis (when first-line amoxicillin fails or in areas with high beta-lactamase prevalence).
ยท Uncomplicated urinary tract infections (UTIs).
ยท Pharyngitis/Tonsillitis (alternative in penicillin allergy, except type I hypersensitivity).
Side Effects:
ยท Gastrointestinal: Diarrhea, nausea, abdominal pain.
ยท Hypersensitivity reactions: Rash, urticaria (cross-reactivity with penicillins ~5-10%).
ยท Less common: Headache, dizziness, vaginitis, transient elevation of liver enzymes.
Important:
ยท Use with caution in patients with penicillin allergy (contraindicated in type I/immediate hypersensitivity).
ยท No activity against MRSA, Enterococci, or Pseudomonas.
ยท May cause false-positive urinary glucose with copper reduction tests (Clinitest).
ยท Can be taken with or without food (absorption is slower but not reduced with food).