cefixime
Sources réglementaires consultées
Indications approuvées
- Infections respiratoires, otite moyenne et infections urinaires non compliquées dues à des germes sensibles.
Contre-indications
Absolues
- Hypersensibilité au céfixime ou à d’autres céphalosporines.
Mises en garde cliniques
- Mise en garde majeure · Une hypersensibilité sévère ou une anaphylaxie peut survenir ; rechercher les antécédents d’allergie aux bêta-lactamines et arrêter en cas de réaction allergique. — CIMA/AEMPS, ficha técnica 66398
- Mise en garde majeure · Une diarrhée et une colite à Clostridioides difficile peuvent survenir pendant ou après le traitement ; évaluer toute diarrhée importante. — CIMA/AEMPS, ficha técnica 66398
- Mise en garde majeure · Des convulsions ont été rapportées, surtout en cas d’insuffisance rénale ou de doses non ajustées ; adapter à la fonction rénale et arrêter en cas de convulsion. — CIMA/AEMPS, ficha técnica 66398
Interactions médicamenteuses
- SévèreWarfarine et anticoagulants
Mécanisme: Il peut prolonger le temps de prothrombine et augmenter l’INR.
Recommandation: Surveiller l’INR et les signes de saignement.
CIMA/AEMPS, ficha técnica 66398
- ModéréeCarbamazépine
Mécanisme: Le céfixime peut augmenter les concentrations de carbamazépine.
Recommandation: Surveiller les concentrations et la toxicité de la carbamazépine.
CIMA/AEMPS, ficha técnica 66398
Effets indésirables
Communs (≥1%)
Nausées, diarrhée et éruption cutanée
Rares mais graves
Anaphylaxie, colite à C. difficile et cytopénies sévères
Grossesse et allaitement
Pendant la grossesse, utiliser uniquement en cas d’indication clinique. Évaluer l’allaitement selon l’exposition dans le lait et l’état du nourrisson décrits dans le résumé des caractéristiques du produit.
Bibliographie récente (PubMed)
Cefixime is an antibiotic from the cephalosporin class used to treat various bacterial infections. The purpose of performing this review is to thoroughly evaluate the pharmacokinetic (PK) data on cefiximeFive databases were systematically searched to identify studies on the PK of cefixime.A total of 38 articles meeting the eligibility criteria were included that provide data on concentration-time profiles or PK parameters such as peak plasma and serum concentration (Cmax), area under the curve (AUC), clearance (CL), and time to reach Cmax (tmax). A dose-dependent increase in AUC and Cmax of cefixime was depicted in healthy volunteers. The clearance of cefixime decreased according to the degree of renal insufficiency among haemodialysis patients. A significant difference in CL was found in comparing fasted and fed states. A biphasic decline in serum concentrations of cefixime was reported when it was taken without probenecid.This review compiles all the reports on the PK of cefixime in healthy and really impaired patients; the summarised information can be used to optimise cefixime dosing in different disease states. Moreover, cefixime has increased time above MIC value suggesting that it may be an effective treatment for infections caused by certain pathogens.
The European guideline on the management of epididymo-orchitis has been updated in 2024. This guideline offers advice on the diagnosis, investigation, treatment and follow-up for the management of epididymo-orchitis. For treatment of patients with a history suggestive of sexually transmitted pathogens-ceftriaxone dose increased to 1 g intramuscularly (IM) single dose alongside doxycycline. The use of dual therapy with azithromycin is no longer recommended, unless cefixime is being given as an alternative to ceftriaxone. For treatment of patients with a history including risks for both sexually transmitted and enteric pathogens-ceftriaxone IM single dose and either ofloxacin or levofloxacin is recommended. Where enteric pathogens are suspected as the likely cause, either ofloxacin or levofloxacin is recommended as monotherapy. This guideline covers a range of clinical scenarios, including rarer and non-sexually transmitted causative agents.
Typhoid and paratyphoid (enteric fever) are febrile bacterial illnesses common in many low- and middle-income countries. The World Health Organization (WHO) currently recommends treatment with azithromycin, ciprofloxacin, or ceftriaxone due to widespread resistance to older, first-line antimicrobials. Resistance patterns vary in different locations and are changing over time. Fluoroquinolone resistance in South Asia often precludes the use of ciprofloxacin. Extensively drug-resistant strains of enteric fever have emerged in Pakistan. In some areas of the world, susceptibility to old first-line antimicrobials, such as chloramphenicol, has re-appeared. A Cochrane Review of the use of fluoroquinolones and azithromycin in the treatment of enteric fever has previously been undertaken, but the use of cephalosporins has not been systematically investigated and the optimal choice of drug and duration of treatment are uncertain. To evaluate the effectiveness of cephalosporins for treating enteric fever in children and adults compared to other antimicrobials. We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, the WHO ICTRP and ClinicalTrials.gov up to 24 November 2021. We also searched reference lists of included trials, contacted researchers working in the field, and contacted relevant organizations. We included randomized controlled trials (RCTs) in adults and children with enteric fever that compared a cephalosporin to another antimicrobial, a different cephalosporin, or a different treatment duration of the intervention cephalosporin. Enteric fever was diagnosed on the basis of blood culture, bone marrow culture, or molecular tests. We used standard Cochrane methods. Our primary outcomes were clinical failure, microbiological failure and relapse. Our secondary outcomes were time to defervescence, duration of hospital admission, convalescent faecal carriage, and adverse effects. We used the GRADE approach to assess ce
The paper presents various issues related to the increasing drug resistance of Neisseria gonorrhoeae and the occurrence and spread of multidrug-resistant clones. One of the most important is the incidence and evolution of resistance mechanisms of N. gonorrhoeae to beta-lactam antibiotics. Chromosomal resistance to penicillins and oxyimino-cephalosporins and plasmid resistance to penicillins are discussed. Chromosomal resistance is associated with the presence of mutations in the PBP2 protein, containing mosaic variants and nonmosaic amino acid substitutions in the transpeptidase domain, and their correlation with mutations in the mtrR gene and its promoter regions (the MtrCDE membrane pump repressor) and in several other genes, which together determine reduced sensitivity or resistance to ceftriaxone and cefixime. Plasmid resistance to penicillins results from the production of beta-lactamases. There are different types of beta-lactamases as well as penicillinase plasmids. In addition to resistance to beta-lactam antibiotics, the paper covers the mechanisms and occurrence of resistance to macrolides (azithromycin), fluoroquinolones and some other antibiotics. Moreover, the most important epidemiological types of multidrug-resistant N. gonorrhoeae, prevalent in specific years and regions, are discussed. Epidemiological types are defined as sequence types, clonal complexes and genogroups obtained by various typing systems such as NG-STAR, NG-MAST and MLST. New perspectives on the treatment of N. gonorrhoeae infections are also presented, including new drugs active against multidrug-resistant strains.
Safe and efficacious alternative treatment options for syphilis are necessary. This randomized, 2-arm, noncomparative pilot study evaluated the efficacy of oral cefixime 400 mg in achieving a ≥4-fold rapid plasma reagin titer decrease by 3 or 6 months after treatment. The proportion of cefixime arm participants treated successfully was 87% (95% confidence interval, 69%-100%; 13/15). Clinical Trials Registration. NCT03752112.