Cefixime

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Cefixime, sold under the brand name Suprax among others, is an antibiotic medication used to treat a number of bacterial infections.<ref name=AHFS2016/> These infections include otitis media, strep throat, pneumonia, urinary tract infections, gonorrhea, and Lyme disease.<ref name=AHFS2016/> For gonorrhea typically only one dose is required.<ref name=WHO2008>Template:Cite book</ref> In the United States it is a second-line treatment to ceftriaxone for gonorrhea.<ref name=AHFS2016/> It is taken by mouth.<ref name=AHFS2016/>

Common side effects include diarrhea, abdominal pain, and nausea.<ref name=AHFS2016/> Serious side effects may include allergic reactions and Clostridioides difficile diarrhea.<ref name=AHFS2016/> It is not recommended in people with a history of a severe penicillin allergy.<ref name=WHO2008/> It appears to be relatively safe during pregnancy.<ref name="Drugs.com pregnancy">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> It is in the third-generation cephalosporin class of medications.<ref name=AHFS2016/> It works by disrupting the bacteria's cell wall resulting in its death.<ref name=AHFS2016>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Cefixime was patented in 1979 and approved for medical use in the United States in 1989.<ref name=AHFS2016/><ref name=Fis2006>Template:Cite book</ref> It is on the World Health Organization's List of Essential Medicines.<ref name="WHO21st">Template:Cite book</ref> It is available as a generic medication in the United States.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Medical uses

Cefixime treats infections of the:

• Urinary tract: Uncomplicated urinary tract infections caused by susceptible isolates of Escherichia coli and Proteus mirabilis.<ref name="Suprax FDA label" /><ref name="Suprax SmPC" /><ref name=AHFS2016/>
• Ear: Otitis media caused by Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes.<ref name="Suprax FDA label" /><ref name="Suprax SmPC" /><ref name=AHFS2016/>
• Throat: Tonsillitis and pharyngitis caused by Streptococcus pyogenes.<ref name="Suprax FDA label" /><ref name="Suprax SmPC" /><ref name=AHFS2016/>
• Chest and lungs: Chronic bronchitis caused by Streptococcus pneumoniae and Haemophilus influenzae.<ref name="Suprax FDA label" /><ref name="Suprax SmPC" /><ref name=AHFS2016/>
• Cervix and urethra: Gonorrhea (cervical/urethral) caused by susceptible isolates of Neisseria gonorrhoeae (penicillinase-and non-penicillinase-producing isolates).<ref name="Suprax FDA label" /><ref name="Suprax SmPC" /><ref name=AHFS2016/>
• Skin and soft tissue infection: effective against group A and B beta-hemolytic streptococci. However, Staphylococcus aureus, coagulase-negative staphylococci and enterococci are resistant.<ref name=":0">Template:Cite book</ref>

It is also used to treat typhoid fever.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref name=AHFS2016/>

Spectrum of bacterial susceptibility

Cefixime is a broad spectrum cephalosporin antibiotic and is commonly used to treat bacterial infections of the ear, urinary tract, and upper respiratory tract. The following represents MIC susceptibility data for a few medically significant microorganisms:<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

• Escherichia coli: 0.015 μg/mL – 4 μg/mL
• Haemophilus influenzae: ≤0.004 μg/mL – >4 μg/mL
• Proteus mirabilis: ≤0.008 μg/mL – 0.06 μg/mL
• Streptococcus pneumoniae: 0.12 μg/mL<ref name=":0" />
• Staphylococcus aureus: >128 μg/mL (Resistant)<ref name=":0"/>
• Enterobacter spp.: >128 μg/mL (Resistant) <ref name=":0"/>

Mechanism of action

The bactericidal action of Cefixime is due to the inhibition of cell wall synthesis.Template:Medcn It binds to one of the penicillin binding proteins (PBPs) which inhibits the final transpeptidation step of the peptidoglycan synthesis in the bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.Template:Medcn

Absorption Only 40–50% is absorbed from the GI tract (oral bioavailability). Absorption may be slowed but not decreased when taken with food. Average peak concentration after administration of oral suspension is approximately 25–50% greater than the peak concentration following oral tablet or capsules administration.<ref name="Suprax FDA label" />

Distribution It has high concentrations in bile and urine. It can cross the placenta and its protein binding capacity is 65%.Template:Medical citation needed

Contraindications

Cefixime is contraindicated in patients with known sensitivity or allergies to cephalosporin class of antibiotics.<ref name="Suprax FDA label">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> As Cefixime is a third generation cephalosporin, it is not contraindicated for patients with a true penicillin allergy.

Adverse effects

{{ safesubst:#invoke:Unsubst||date=__DATE__ |$B= {{ safesubst:#invoke:Unsubst||date=__DATE__ |$B= Template:Ambox }} }} Adverse drug reactions include diarrhea, dyspepsia, nausea and vomiting.<ref name="AHFS2016" /> Hypersensitivity reactions like skin rashes, urticaria and Stevens–Johnson syndrome have been reported.Template:Medcn There is no specific antidote for cefixime overdosage.Template:Medcn

Drug interactions

• Alcohol – No major interaction has been observed between cefixime and alcohol.<ref>{{#invoke:citation/CS1|citation

|CitationClass=web }}</ref>Template:Better source needed

History

It was sold under the trade name Suprax 125 in the United States until 2003, when it was taken off the market by drug manufacturer Wyeth after its patent expired.Template:Citation needed Lupin started selling Suprax in the United States in 2007,<ref name="ANDA 065355">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> and it is available in different formulations and strengths.<ref name="ANDA 065355" /><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Marketing

Cefixime is marketed under many brand names worldwide; examples include Fixacef, Pancef, Caricef, Taxim o, Texit, Ofex, Ceftid, Cef-3, Denvar, 3-C, Cefim, Magnett, Oroken, Ofiken, Fix-A, and Zifi.<ref name=genericnames>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="FDC—Products—Formulations">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> In India it is marketed as Zifi 200 and is commonly counterfeited.<ref>Template:Cite news</ref>