The use of Cefixime for childhood infections

Introduction

Cefixime is a broad-spectrum, third-generation cephalosporin antibiotic derived semisynthetically from the marine fungus Cephalosporium acremonium with antibacterial activity. As does penicillin, the beta-lactam antibiotic cefixime inhibits bacterial cell wall synthesis by disrupting peptidoglycan synthesis, reducing bacterial cell wall stability and bacterial cell lysis. It exerts its bactericidal effect by attaching to penicillin-binding proteins and inhibiting peptidoglycan synthesis, thus causing damage to the bacterial cell wall. Stable in the presence of a variety of beta-lactamases, this agent is more active against gram-negative bacteria and less active against gram-positive bacteria compared to second-generation cephalosporins[1].

Used in children

Although cefixime is an effective antibiotic in many situations, less expensive and equally effective alternatives are frequently available. The following are guidelines on the use of cefixime in children:

For otitis media, since S pneumoniae is the most common bacterial pathogen, cefixime does not offer any advantages over less expensive agents such as amoxicillin, trimethoprim-sulfamethoxazole and erythromycin-sulfisoxazole. While beta-lactamase produces H influenzae and M catarrhalis, which are common pathogens in otitis media, amoxicillin is effective even in many cases[2].

For streptococcal pharyngitis, penicillin V remains the treatment of choice. Only penicillin has been studied and reported to be effective in preventing rheumatic fever. However, suitable antibiotic alternatives include erythromycin and cephalosporins. Cefixime and other less expensive first- and second-generation cephalosporins effectively treat streptococcal sore throat.

As yet, insufficient published controlled studies show cefixime to be effective for treating children with sinusitis, ‘bronchitis’ or pneumonia. However, its antimicrobial spectrum does include the bacterial pathogens that commonly cause sinusitis and pneumonia in children.

For urinary tract infections, cefixime offers little advantage over less expensive agents such as amoxicillin, trimethoprim-sulfamethoxazole and nitrofurantoin. However, cefixime can treat urinary pathogens resistant to those antibiotics but susceptible to cefixime.

Single-dose cefixime is effective in treating uncomplicated gonorrhea infections, while longer duration is required to treat pelvic inflammatory disease caused partly by N gonorrhoeae. However, it is controversial whether cefixime is effective in treating pharyngeal gonorrhea.

Cefixime is effective for the treatment of young children (where quinolone antibiotics are contra-indicated) with gastroenteritis caused by Salmonella and Shigella species that are resistant to traditional antibiotics such as amoxicillin and trimethoprim-sulfamethoxazole. However, it is unknown whether resistance will eventually develop in these pathogens with the increasing use of cefixime.

Preliminary evidence suggests that switching to oral cefixime may be an effective alternative (after initial parenteral antibiotic therapy) in preventing the occurrence of serious Gram-negative infections in oncology patients recovering from febrile neutro- penia. However, controlled studies are awaited.

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