Cefixime

What is Cefixime?

Cefixime is a third-generation oral cephalosporin antibiotic used to treat a range of bacterial infections including urinary tract infections, certain respiratory infections, and uncomplicated gonorrhoea caused by Neisseria gonorrhoeae. It is listed on the WHO Model List of Essential Medicines and has been included in European STI treatment guidelines.

Cefixime offers broad-spectrum bactericidal activity against gram-negative organisms and is valued for its oral bioavailability, making it accessible without requiring an injection. However, increasing antibiotic resistance in Neisseria gonorrhoeae has led guidelines to shift emphasis toward injectable ceftriaxone as the preferred first-line option.

How does Cefixime work?

Cefixime is a beta-lactam antibiotic that kills bacteria by inhibiting cell wall synthesis. It binds to penicillin-binding proteins (PBPs) on the bacterial surface, blocking the final stage of peptidoglycan cross-linking that gives bacterial cell walls their structural rigidity. Without an intact cell wall, bacteria lyse and die.

Compared to first- and second-generation cephalosporins, cefixime has enhanced stability against many beta-lactamase enzymes produced by gram-negative bacteria, giving it broader gram-negative coverage. Key properties include:

• Oral administration: Unlike many third-generation cephalosporins, cefixime is well absorbed orally (40–50% bioavailability)
• Gram-negative coverage: Strong activity against Neisseria gonorrhoeae, Haemophilus influenzae, and E. coli
• Renal excretion: Primarily eliminated unchanged by the kidneys
• Long half-life: Allows once-daily dosing in many indications

Who is Cefixime for?

Cefixime is indicated for the treatment of infections caused by susceptible bacteria, including:

• Urinary tract infections (UTIs): Caused by susceptible gram-negative organisms such as E. coli
• Upper respiratory tract infections: Such as otitis media, sinusitis, and pharyngitis
• Uncomplicated gonorrhoea: Urethral, cervical, and rectal gonorrhoea in adults when ceftriaxone is not available or appropriate, and local susceptibility data support use

Current gonorrhoea treatment guidance: European STI guidelines and the WHO recommend confirming antibiotic susceptibility before using oral agents for gonorrhoea, as multi-drug resistant strains are increasingly prevalent. Always follow the current guidance provided by the treating doctor.

Cefixime is not effective against:

• Viral infections (herpes, HPV, HIV)
• Fungal infections
• Chlamydia trachomatis (requires different antibiotic classes such as azithromycin or doxycycline)

Dosage

Cefixime is available as tablets (200 mg, 400 mg) and oral suspension. It can be taken with or without food. If nausea is an issue, taking it with food may help.

Note for gonorrhoea treatment: Current European guidelines recommend that gonorrhoea treatment should ideally be confirmed with culture and sensitivity testing. Cefixime should only be used for gonorrhoea when local resistance patterns and test results support its use, and when followed by a test of cure.

Side effects

Common side effects (affecting 1 to 10 in 100 people)

• Diarrhoea
• Nausea
• Abdominal pain
• Loose stools

Less common side effects

• Vomiting
• Headache
• Dizziness
• Flatulence
• Dyspepsia (indigestion)

Serious side effects (rare)

• Hypersensitivity reactions: From mild urticaria (hives) to anaphylaxis — seek emergency help immediately if this occurs
• Clostridioides difficile colitis: Severe, persistent diarrhoea possibly with blood — discontinue and seek medical attention
• Stevens-Johnson syndrome / toxic epidermal necrolysis: Rare serious skin reactions
• Haematological effects: Including neutropenia, thrombocytopenia, and haemolytic anaemia with prolonged use

Cefixime vs other gonorrhoea treatments

Clinical context: Injectable ceftriaxone is preferred over oral cefixime for gonorrhoea. The previously quoted 500 mg or 1 g IM examples come from differing guidance and are not interchangeable current WHO recommendations. The use of oral cefixime for gonorrhoea should be guided by sensitivity testing and prescribed by a doctor with awareness of current local resistance patterns.

Online assessment for Cefixime

Cefixime is a prescription-only medicine (POM) in all EU member states. It cannot legally be dispensed without a valid prescription from a licensed medical professional.

Prescrivia operates as a technology intermediary: we do not prescribe medicines, employ doctors, or sell medicines. Our platform connects patients with independent doctors who can conduct confidential online health assessments.

Availability of an online assessment, prescribing, dispensing and delivery depends on the medicine, country and applicable law. Spain prohibits distance sale of prescription medicines; a catalogue entry or cross-border prescription does not establish a right to delivery. An in-person examination or testing may be required.

The process, where legally and clinically available:

1. Complete a health assessment: Provide details of your symptoms, sexual history, any prior STI testing, and medications or allergies.
2. Doctor review: An independent doctor reviews your assessment. If cefixime is clinically appropriate based on your circumstances, they may issue a prescription.
3. Pharmacy fulfilment: The prescription is sent to a pharmacy partner to assess dispensing and any supply under the applicable country rules.

Important: Prescrivia does not guarantee that a prescription will be issued. For gonorrhoea, testing and culture are strongly recommended. All prescribing decisions are made independently by qualified medical professionals.

Important safety information

Tell your doctor before taking Cefixime if you:

• Have a known allergy to cephalosporins or penicillins
• Have kidney disease (dose reduction may be required)
• Are pregnant or breastfeeding
• Have a history of gastrointestinal disease, especially colitis
• Are taking any other medicines, including anticoagulants (cefixime may interact with warfarin)

Test of cure: After treatment for gonorrhoea, a test of cure (repeat testing 1–2 weeks after treatment) is strongly recommended to confirm successful eradication of the infection, as per European STI guidelines.

Partner notification: If diagnosed with gonorrhoea or another STI, sexual partners should be informed and offered testing and treatment. This is an important step in preventing reinfection and reducing transmission.

Sources

• Product information / clinical reference 1

Medical information on this page is based on the following sources:

• World Health Organization (WHO). WHO Guidelines for the Treatment of Neisseria gonorrhoeae. 2016. who.int
• European STI Guidelines Editorial Board. 2021 European guideline on the diagnosis and treatment of gonorrhoea in adults. Journal of the European Academy of Dermatology and Venereology.
• World Health Organization (WHO). WHO Model List of Essential Medicines. 22nd edition, 2021.

The content-edit date does not certify a clinical review. It is provided for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for advice relevant to your individual health circumstances.