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Cefixime
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Cefixime is an orally administered cephalosporin with a broader antimicrobial spectrum than those of earlier oral cephalosporins, such as cephalexin and cefaclor. It is referred to as a third-generation oral cephalosporin, but its spectrum of activity is not quite as wide as those of other oral third-generation cephalosporins (e.g. cefpodoxime) or parenteral third-generation cephalosporins (e.g. cefotaxime) (Anonymous, 1989). Its molecular weight is 453. Its chemical structure is shown in Figure 29.1.
Infection and sexual health
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Uncomplicated anogenital infection in adults: Ceftriaxone 500 mg IM as a single dose plus azithromycin 1 g oral as a single dose (Grade C recommendation). This is first-line treatment due to concerns around drug resistance and drug failures. Azithromycin is always recommended as a co-treatment to epidemiologically treat chlamydia, but even if chlamydia negative there is evidence that it might delay the widespread onset of cepha-losporin resistance.Cefixime 400 mg oral as a single dose. Only if there are contraindications to an IM injection or refused (Grade A recommendation)orSpectinomycin 2 g IM as a single dose (Grade A recommendation).
Infections
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
There are only a few studies on treatment of children with UTI that fulfil modern standards for clinical trials. Mostly local traditions and beliefs guide treatment recommendations. There are many difficulties in performing randomised clinical trials in small children and a major obstacle is to include adequate numbers of patients. The most relevant end-point to study is probably development of permanent renal damage, both incidence and extent, which with the techniques available today will require repeated scintigraphies. Other possibilities are to look at sterilisation of urine, time for fever resolution, and incidence of early recurrence of UTI. Hoberman et al. studied all these factors in children 1 to 24 months of age with febrile UTI [13]. A total of 306 children were allocated to either oral cefixime for 14 days or initial intravenous cefotaxime for 3 days, followed by oral cefixime for 11 days. The overall results were excellent with sterilisation of urine after 24 hours in all patients and a very low incidence of permanent renal damage at 6 months, 9% as determined by scintigraphy. More importantly, there was no difference in outcome between the treatment groups for any of the end-points. The same results were found in two smaller studies of children with febrile UTI [14,15]. However, children who were seriously ill with suspected or evident hypotension, or who vomited, were excluded in these studies. Certainly, children with such symptoms should be given parenteral treatment. Otherwise, drugs such as trimethoprim and the modern oral cephalosporins, rapidly attain high concentrations in urine and renal tissue and should be as effective in eradicating bacteria as antibiotics given parenterally to children with acute pyelonephritis.
Breakthrough pneumonia, meningitis and bloodstream infection due to Streptococcus pneumoniae during cefixime therapy
Published in Journal of Chemotherapy, 2019
Novella Carannante, Carlo Pallotto, Mariano Bernardo, Enza Mallardo, Giovanni Di Caprio, Giulia Palmiero, Vittorio Attanasio, Carlo Tascini
A 20 year-old female was admitted for community-acquired pneumonia. The patient suffered from shaking chills, fever and cough for 5 days. The patient was treated with cefixime (400 mg per day) according to her general practitioner’s prescription. Despite this antibiotic therapy, fever and cough persisted. A chest CT scan was performed and revealed a bilateral lobar pneumonia so that the patient was admitted to our hospital. At admission SOFA score was 4 with FiO2 90%, platelets count 140,000/ml, Glasgow coma scale (GCS) 15, Bilirubin 0.8 mg/dl, blood pressure 90/60 mmHg, creatinine 1.7 mg/dl, C-reactive protein (CRP) was 36.6 mg/dl, procalcitonin (PCT) was 18.7 ng/ml, leucocytes count was 10700/mm3, blood cultures were positive for S. pneumoniae. Treatment with ceftriaxone 2 g/day and rifampin 600 mg/day was started with resolution of symptoms in 3 days. Also, blood cultures turned negative in 3 days of treatment. S. pneumoniae antibiogram showed intermediate susceptibility to penicillin (MIC 0.38 mg/L), susceptibility but with increased MIC to ceftriaxone (0.25 mg/L) and MIC for cefixime equal to 4 mg/L. S. pneumoniae was characterized as serotype 14.
Early Buckle Migration and Restrictive Strabismus after Successful Medical Management of Scleral Buckle Infection
Published in Journal of Binocular Vision and Ocular Motility, 2019
V G Madanagopalan, Fredrick Mouttapa, Jivitesh Singh
On the second post-operative day, the patient presented with pain, chemosis, restricted ocular movements, diplopia, and purulent discharge at the sites of conjunctival suturing (Figure 1a). There was no exposure of the SB or sutures. There was no intraocular inflammation and the retina was attached. Microbial analysis of the purulent discharge showed the presence of methicillin resistant Staphyloccus aureus (MRSA). The isolate was susceptible to cephalosporins. Intense systemic therapy with intravenous cefotaxime (1000 mg/day) and topical therapy with fortified cefazolin (every two hours) was instituted for 5 days. Prompt reduction in lid edema, chemosis and discharge was seen at two days. The retina remained attached, as inferior support provided by the SB was not removed. Oral cefixime (400 mg/day) was continued for 7 days. Clinical improvement evidenced by reduction of conjunctival congestion and discharge was well marked at day 7 (Figure 1b) and complete resolution of SB infection was seen by 1 month (Figure 1c).
Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence
Published in Paediatrics and International Child Health, 2018
Phoebe C. M. Williams, James A. Berkley
Cefixime is an oral third-generation cephalosporin which inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs), inhibiting cell wall synthesis. It is widely distributed throughout the body and reaches therapeutic concentration levels in most tissues and body fluids, with a time to peak serum concentration of 2–6 h and a half-life of 3–4 h [25]. Cefixime has been demonstrated to be effective (at 8 mg/kg/day in two divided doses) for shigellosis in adults and paediatric patients [26–29], although one study documented inferior efficacy to that of azithromycin [27]. Short (2-day) courses have been found to be as effective as 5-day courses [27,29]. Cefixime may be useful for paediatric patients when cephalosporin is necessary owing to high resistance to fluoroquinolones and β-lactams, and it can be taken orally. Cefixime is affordable and the suspension can be stored at room temperature [28]. Updated clinical trials to investigate this therapy as an alternative treatment option are urgently needed because previous randomised controlled trials investigating its efficacy are over a decade old.