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PHARMACEUTICAL FORM
Powder for oral suspension.
Off-white to pale yellow coloured powder with characteristic odour and gives a cream
colour to pale yellow coloured viscous suspension after reconstitution with water.
CLINICAL PARTICULARS
4.1
Therapeutic indications
Cefixime is indicated for the treatment of the following infections when caused by
susceptible organisms (see sections 4.4 and 5.1)
Acute exacerbations of chronic bronchitis
Community-acquired Pneumonia
Lower urinary tract infections
Pyelonephritis
In the treatment of:
Otitis media
Sinusitis
Pharyngitis
The use of Cefixime should be reserved for infections where the causative organism
is known or suspected to be resistant to other commonly used antibiotics, or where
treatment failure may carry significant risk.
Consideration should be given to official guidance on the appropriate use of
antibacterial agents.
4.2
Daily dose
5 kg
10 kg
12.5 kg
15 kg
17.5 kg
20 kg
22.5 kg
25 kg
40 mg
80 mg
100 mg
120 mg
140 mg
160 mg
180 mg
200 mg
Children weighing more than 50 kg or older than 10 years should be treated with the
recommended adult dose (200 -400 mg daily), depending on the severity of the
infection.
Children younger than 6 months of age
The safety and efficacy of cefixime has not been established in children less than 6
months.
Renal impairment
Cefixime may be administered in the presence of impaired renal function. Normal
dose and schedule may be given in patients with creatinine clearance of 20 ml/ min or
greater. In patients whose creatinine clearance is less than 20 ml/min, it is
recommended that a dose of 200 mg once daily should not be exceeded. The dose and
regimen for patients who are maintained on chronic ambulatory dialysis or
haemodialysis should follow the same recommendation as that for patients with
creatinine clearance of less than 20 ml/min.
Method of administration
Cefixime powder for oral suspension is for oral administration only.
The absorption of cefixime is not significantly affected by the presence of food.
Hence it can be administered with or without food.
4.3
Contraindications
Patients with known hypersensitivity to cefixime, other cephalosporin antibiotics or
to any of the excipients.
Cefixime is also contraindicated in patients with previous, immediate and/or severe
hypersensitivity to penicillin or any beta-lactam antibiotics and preterm and term
newborn infants (0-27 days).
4.4
colitis should be excluded. The use of medicinal products inhibiting the intestinal
peristalsis is contra-indicated.
Cefixime contains sucrose. Patients with rare hereditary problems of galactose
intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should
not take this medicine.
Use of Nifedipine, a calcium channel blocker, may increase bioavailability of
Cefixime upto 70%.
Renal insufficiency
Cefixime should be administered with caution in adult patients with creatinine
clearance <20ml/min (see sections 4.2 and 5.2). There are insufficient data regarding
use of cefixime in the pediatric and adolescent age group in the presence of renal
insufficiency: the use of cefixime in these patient-groups is not recommended.
4.5
4.6
benefit of cefixime therapy to the woman. However, until further clinical experience
is available, cefixime should not be prescribed to breast-feeding mothers.
Fertility
Animal studies do not indicate any harmful effects with respect to fertility, however,
no clinical data are available
4.7
4.8
Undesirable effects
Cefixime, like other cephalsporin antibiotics, may be associated with adverse events.
Within each frequency grouping, undesirable effects are presented in order of
decreasing seriousness.
The following undesirable effects have been divided in the following categories:
Very common:
Common:
Uncommon:
Rare:
Very rare:
Not known:
>1/10
>1/100 to <1/10
>1/1,000 to <1/100
>1/10,000 to <1/1,000
<1/10,000
cannot be estimated from the available data
Adverse Reaction
Frequency
Superinfection bacterial,
superinfection fungal
Antibiotic-associated colitis
(see section
Eosinophilia
Leucopenia, agranulocytosis,
pancytopenia,
thrombocytopenia, haemolytic
anaemia
Hypersensitivity
Anaphylactic shock, serum
sickness
Anorexia
Rare
Rare
Headache
Vertigo, dizziness
Psychomotor hyperactivity
Uncommon
Rare
Very rare
Very rare
Rare
Very rare
Rare
Very rare
Gastrointestinal disorders
Hepatobiliary disorders
Investigations
4.9
Diarrhoea
Abdominal pain, nausea,
vomiting
Flatulence
Cases of pseudomembraneous
colitis
Hepatitis, cholestatic jaundice
Rash
Angioneurotic oedema,
pruritus
Stevens-Johnson Syndrome,
toxic epidermal necrolysis,
Lyell syndrome
Interstitial nephritis
Common
Uncommon
Mucosal inflammation,
pyrexia
Rare
Uncommon
Rare
Very rare
Very rare
Uncommon
Rare
Very rare
Very rare
Rare
Very rare
Overdose
There is no experience with overdoses with Cefixime.
Adverse reactions seen at dose levels up to 2 g of cefixime in normal subjects did not
differ from the profile seen in patients treated at the recommended doses. Gastric
lavage may be indicated in overdosage. No specific antidote exists. Cefixime is not
removed from the circulation in significant quantities by dialysis.
PHARMACOLOGICAL PROPERTIES
5.1
Pharmacodynamic properties
Pharmacotherapeutic group: antibacterial for systemic use, belonging to the class of
cephalsporins, ATC code: J01DD08.
Mode of action
Cefixime is an antibiotic belonging to the third generation cephalosporin group.
Like other cephalsporins, cefixime exerts antibacterial activity by binding to and
inhibiting the action of penicillin-binding proteins involved in the synthesis of
bacterial cell walls. This leads to bacterial cell lysis and cell death.
PK/PD Relationship
The time that the plasma concentration of cefixime exceeds the MIC of the infecting
organism has been shown to best correlate with efficacy in PK/PD studies.
Mechanism of resistance
Bacterial resistance to cefixime may be due to one or more of the following
mechanisms:
5.2
Pharmacokinetic properties
Absorption
5.3
PHARMACEUTICAL PARTICULARS
6.1
List of excipients
Xanthum gum
Sodium benzoate
Silica colloidal, anhydrous
Sucrose
Flavour strawberry (maltodextrin, triethyl acetate E1505, propylene glycol E1520)
6.2
Incompatibilities
Not applicable.
6.3
Shelf life
Unopened: 2 years.
After reconstitution: The reconstituted suspension may be stored for 14 days below
25oC.
6.4
6.5
6.6
Bottle
size
100 mg/ 5 ml
100 ml
Any unused product or waste material should be disposed of in accordance with local
requirements.
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