Cefixime: Patient Guide for Australia
Basic Product Information
| International Non-proprietary Name (INN) | Cefixime |
|---|---|
| Common Australia Brand Names | Suprax, Cephorum, generic options |
| ATC Code | J01DD08 (Cefixime) |
| Available Forms & Strengths | Tablets (200 mg, 400 mg), Capsules (200 mg), Oral Suspension (100 mg/5 mL) |
| Manufacturers | Multiple, including Alphapharm, Ranbaxy, Sandoz (generic supplies) |
| Prescription Status AU | Schedule 4 – Prescription Only Medicine (requires a prescription from a GP or specialist) |
Mechanism of Action
For patients: Cefixime is a cephalosporin-type antibiotic. It works by fighting certain bacteria causing common infections like chest, throat, urinary tract, and some sexually transmitted infections. It does this by stopping the bacteria from making a protective wall, leading to their death.
For specialists: Cefixime is a third-generation cephalosporin that binds to penicillin-binding proteins, inhibiting the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, leading to cell lysis. Its spectrum is broader than older cephalosporins (notably against Enterobacteriaceae, some Neisseria spp.).
Pharmacokinetics
- Absorption: Well absorbed orally; bioavailability ~40–50%. Oral suspension can be slightly better absorbed than tablets/capsules.
- Metabolism: Minimal hepatic metabolism; most remains unchanged in the bloodstream.
- Elimination: Mainly via urine (50–60%), minor via faeces.
- Half-life: Approximately 3–4 hours in healthy adults.
- Duration of Action: Usually requires once-daily or twice-daily dosing due to the moderate half-life.
Use in Everyday Life and Best Practices (Australia Context)
Cefixime is most commonly used in Australia for treating:
- Urinary tract infections (UTIs)
- Acute bronchitis and pneumonia (chest infections)
- Strep throat and tonsillitis
- Uncomplicated gonorrhoea (sexually transmitted infection)
- Otitis media (middle ear infection)
Typical adult dose is 400 mg once daily or 200 mg twice daily. Children’s doses are calculated by weight. Always take as your doctor instructs and finish the full course.
Dosing in the Morning vs Evening
- Once daily: Take at roughly the same time each day for best effect – morning or evening is suitable, but pick a time easy to remember.
- Twice daily: Aim for every 12 hours (e.g., 8am & 8pm).
- Tips: Consider linking the dose to regular daily activities, like breakfast or brushing teeth.
- Advantages/Disadvantages: No major difference in side effects based on time of day; consistency is most important. Nighttime dosing may reduce disturbance if mild nausea occurs.
Taking with Food or on an Empty Stomach
- Cefixime can be taken with or without food.
- Taking with food may help reduce mild stomach upset (nausea or indigestion), though food slightly delays absorption.
- Australia diet tip: Taking medication after a meal (such as breakfast or dinner) can make remembering easier without affecting efficacy.
Interaction Warnings
| Type | Interaction | Advice |
|---|---|---|
| Food | No significant effect. Food might delay absorption slightly, but not clinically important. | Take with or without food. |
| Alcohol | No direct interaction. However, alcohol may increase the risk of stomach upset or mask fever/infection symptoms. | Limit alcohol while unwell or on antibiotics. |
| Antacids | Antacids with aluminium/magnesium can slow cefixime absorption. | Take cefixime at least 2 hours before/after antacids. |
| Warfarin & anticoagulants | May enhance anticoagulant effect (rare). | Monitor INR closely. Inform your doctor if you take blood thinners. |
| Oral contraceptives | Rarely, antibiotics may reduce the effectiveness of oral contraceptives. | For added security, consider additional contraception during and 7 days after antibiotic treatment. |
| Other Antibiotics | Risk of reduced efficacy or increased side effects if combined. Not recommended unless advised by a doctor. | Let your healthcare provider know all your medications. |
Indications
| Approved Indications (Australia) | Off-label/Additional Uses |
|---|---|
|
|
Dosing According to Clinical Indications
| Indication | Adults/Elderly | Paediatric (6 months+) |
|---|---|---|
| Uncomplicated UTI | 400 mg once daily or 200 mg twice daily for 5–7 days | 8 mg/kg once daily for 5–7 days |
| Pharyngitis/Tonsillitis | 400 mg once daily or 200 mg twice daily for 5–10 days | 8 mg/kg once daily for 5–10 days |
| Acute bronchitis | 400 mg once daily for 7 days | 8 mg/kg once daily for 7 days |
| Otitis media | 400 mg once daily or 200 mg twice daily for 10 days | 8 mg/kg once daily for 10 days |
| Uncomplicated gonorrhoea | 400 mg as a single dose | Not usually recommended |
| Renal impairment | Adjust dose interval as advised by doctor | Adjust dose interval as advised by doctor |
Always follow your doctor’s specific instructions, as adjustments may be needed for age, weight, and kidney function.
Safety Profile and Side Effects
- Common (1–10%): Diarrhoea, nausea, abdominal pain, gas, headache, dizziness
- Occasional (0.1–1%): Vomiting, rash, itching, increased liver enzyme levels
- Rare (0.01–0.1%): Severe allergic reactions (anaphylaxis, angioedema), Stevens-Johnson syndrome, blood disorders
- Warnings: Seek urgent medical attention for severe rash, swelling, difficulty breathing, severe diarrhoea, or yellowing of the skin/eyes.
| Side Effect | Frequency | Advice |
|---|---|---|
| Diarrhoea | Common | Usually mild; drink fluids. Severe/persistent diarrhoea – see a doctor. |
| Rash, itching | Uncommon | Stop medicine if severe and consult a doctor. |
| Allergy | Rare | Seek immediate help for swelling, breathing trouble, or severe rash. |
| Nausea, abdominal pain | Common | Take with food; see if severe or persistent. |
Guidelines for Proper Use – Australia
- Always take as directed. Complete the full course, even if you feel better.
- Store in a dry place below 25°C; protect from moisture.
- Suspensions should be refrigerated (2–8°C), shaken well before use, and discarded after expiry (usually 14 days once mixed).
- If you forget a dose, take it as soon as you remember. If close to your next dose, skip the missed one—don’t double up.
- Dispose of unused medicine safely—ask your local Australia pharmacy about Return Unwanted Medicines programs.
- Do not share antibiotics with family/friends.
- Tell your doctor if you are pregnant, planning pregnancy, or breastfeeding—cefixime is category B1 (use if clearly needed, usually considered safe).
Alternative Treatment Options (Australia PBS-Listed Alternatives)
- Amoxicillin – widely used first-line antibiotic for respiratory and ear/throat infections; well-tolerated, but not suitable for penicillin-allergic patients.
- Amoxicillin–clavulanate – used when bacterial resistance is likely; larger spectrum, but higher risk of stomach upset or diarrhoea.
- Cefuroxime – another cephalosporin, can be used in some penicillin-allergic patients (cross-reactivity may occur).
- Trimethoprim or Nitrofurantoin – first-line for uncomplicated UTI in adults due to narrow spectrum and urinary targeting.
- Azithromycin or Doxycycline – alternatives for respiratory infections or STIs, especially in penicillin allergy or for atypical pathogens.
All the above are PBS (Pharmaceutical Benefits Scheme) listed; your GP or pharmacist can advise on the best option for your situation.
Legal, Registration and Reimbursement Status in Australia
- Legal Classification: Schedule 4 – Prescription only (Therapeutic Goods Administration, TGA; PBS).
- Registration: Registered for use in Australia by TGA for specified infections.
- Reimbursement: PBS-subsidised only for limited indications; check with your doctor or pharmacist.
- Special Access: May be available under Section 19A (for unregistered brands in shortage cases); confirm with your prescriber.
Latest Research and Clinical Guidance (2022–2025)
- Australian Therapeutic Guidelines (Antibiotic v17, 2024) recognise cefixime as a useful cephalosporin for specific conditions, especially gonorrhoea and penicillin allergy cases.
- Recent global meta-analyses (eg, Lancet Infect Dis 2023; BMJ 2024) confirm efficacy against resistant urinary and respiratory bacterial pathogens, though resistance trends are monitored closely.
- Cefixime remains a WHO-listed essential medicine for certain childhood infections and STI management; use is tailored to local resistance patterns.
Availability and Delivery
| Form/Strength | Popular Pack Sizes | Indicative PBS Price (2024) | Availability | Delivery to Major Cities |
|---|---|---|---|---|
| 400 mg tablets | 5, 6, 7, 10, 14, 20 | PBS co-payment (Concession: ~$7.30; General: ~$30.00) | Most major Australia pharmacies, some may order in |
|
| Oral Suspension (100 mg/5 mL) | 30 mL, 50 mL, 60 mL, 100 mL | PBS listed for children/paediatric use | Major city hospital/outpatient pharmacies; some community pharmacies | As above |
Frequently Asked Questions (FAQ)
- Can I stop cefixime once I feel better?
No, always finish the prescribed course even if symptoms improve – this prevents the infection from returning and reduces resistance risk. - What should I do if I miss a dose?
Take as soon as you remember, unless it’s almost time for your next dose. Do not double up. Continue your regular schedule. - Can I drink alcohol with cefixime?
Moderate drinking is unlikely to cause a problem, but best to limit alcohol as it can increase stomach upset or mask symptoms of illness. - Is cefixime safe if I am pregnant or breastfeeding?
Cefixime is considered safe for use in pregnancy (category B1) and breastfeeding, but always inform your healthcare provider. - What if I have unexpected side effects?
Contact your doctor or pharmacist promptly. For severe allergic symptoms (swelling, severe rash, trouble breathing), seek urgent care.
