Dosing and uses of Suprax (cefixime)
Adult dosage forms and strengths
tablet
- 400mg
tablet, chewable
- 100mg
- 200mg
oral suspension
- 100mg/5mL
- 200mg/5mL
- 500mg/5mL
Acute Bronchitis & Acute Exacerbations of Chronic Bronchitis
400 mg/day PO in single daily dose or divided q12hr
Otitis Media
400 mg/day PO in single daily dose or divided q12hr
Pharyngitis/Tonsillitis
400 mg/day PO in single daily dose or divided q12hr
Uncomplicated Gonorrhea
Alternative treatment of uncomplicated urogenital, anorectal, or pharyngeal gonorrhea if ceftriaxone unavailable; no longer indicated as first-line treatment, per CDC guidelines
400 mg PO once plus azithromycin 1 g PO once (preferred) or alternatively doxycycline 100 mg PO q12hr for 7 days
CDC STD guidelines: MMWR Recomm Rep. June 5, 2015:64(RR3);1-137
Uncomplicated Urinary Tract Infections
400 mg/day PO in single daily dose or divided q12hr
Typhoid Fever (Off-label)
15-20 mg/kg/day PO divided q12hr for 7-14 days
Dosing Modifications
Renal impairment
- CrCl >60 mL/min: Dosage adjustment not necessary
- CrCl 21-60 mL/min: 260 mg/day PO
- CrCl <20 mL/min: 200 mg/day PO
Dosing Considerations
Susceptible organisms
- Escherichia coli, Haemophilus influenzae, Neisseria gonorrhoeae, Proteus mirabilis, Streptococcus pneumoniae, Streptococcus pyogenes, Enterobacteriaceae, Salmonella spp, Serratia spp, Shigella spp
Pediatric dosage forms and strengths
tablet
- 400mg
tablet, chewable
- 100mg
- 200mg
oral suspension
- 100mg/5mL
- 200mg/5mL
- 500mg/5mL
Acute Bronchitis & Acute Exacerbations of Chronic Bronchitis
<6 months: Safety and efficacy not established
6 months-12 years, ≤50 kg: 8 mg/kg/day PO in single daily dose or divided q12hr; not to exceed 400 mg/day
>12 years: 400 mg/day PO in single daily dose or divided q12hr
Otitis Media
<6 months: Safety and efficacy not established
6 months-12 years, ≤50 kg: 8 mg/kg/day PO in single daily dose or divided q12hr; not to exceed 400 mg/day
>12 years: 400 mg/day PO in single daily dose or divided q12hr
Pharyngitis/Tonsillitis
<6 months: Safety and efficacy not established
6 months-12 years, ≤50 kg: 8 mg/kg/day PO in single daily dose or divided q12hr; not to exceed 400 mg/day
>12 years: 400 mg/day PO in single daily dose or divided q12hr
Uncomplicated Gonorrhea
Cervical or urethral gonorrhea
<6 months: Safety and efficacy not established
6 months-12 years, ≤50 kg: 8 mg/kg/day PO in single daily dose or divided q12hr; not to exceed 400 mg/day
>12 years: 400 mg PO once plus azithromycin 1 g in single dose or doxycycline 100 mg PO q12hr for 7 days
Uncomplicated Urinary Tract Infections
<6 months: Safety and efficacy not established
6 months-12 years, ≤50 kg: 8 mg/kg/day PO in single daily dose or divided q12hr; not to exceed 400 mg/day
>12 years: 400 mg/day PO in single daily dose or divided q12hr
Typhoid Fever (Off-label)
15-20 mg/kg/day PO divided q12hr for 7-14 days; not to exceed 400 mg/day
Suprax (cefixime) adverse (side) effects
>10%
Diarrhea (16%)
Frequency not defined
Abdominal pain
Candidiasis
Dizziness
Dyspepsia
Elevated transaminases
Eosinophilia
Erythema multiforme
Fever
Flatulence
Headache
Increased blood urea nitrogen (BUN)
Increased creatinine
Leukopenia
Nausea
Prolonged prothrombin time (PT)
Pruritus
Pseudomembranous colitis
Rash
Serum sickness-like reaction
Stevens-Johnson syndrome
Thrombocytopenia
Urticaria
Vaginitis
Vomiting
Warnings
Contraindications
Documented hypersensitivity
Cautions
Limited activity against anaerobes
Dosage must be adjusted in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Use with caution in patients with history of penicillin allergy
Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy
Pregnancy and lactation
Pregnancy category: B
Lactation: Unknown whether drug is excreted in milk
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Suprax (cefixime)
Mechanism of action
Third-generation oral cephalosporin with broad activity against gram-negative bacteria; by binding to 1 or more penicillin-binding proteins, it arrests bacterial cell-wall synthesis and inhibits bacterial growth
Absorption
Bioavailability: 40-50%
Distribution
Distributed widely throughout body and reaches therapeutic concentration in most tissues and body fluids, including synovial, pericardial, pleural, and peritoneal; bile, sputum, and urine; bone, myocardium, gallbladder, skin, and soft tissue
Protein bound: 65%
Elimination
Half-life: 3-4 hr
Excretion: Urine (50% as unchanged drug), feces (10%)
