Usage
Cefixime + Dicloxacillin is a combination antibiotic used to treat a variety of bacterial infections. This combination is effective against a broad spectrum of gram-positive and gram-negative bacteria, including those that produce penicillinase. It is commonly prescribed for infections of the respiratory tract (e.g., pharyngitis, tonsillitis, bronchitis, pneumonia), skin and soft tissues (e.g., cellulitis, impetigo, abscesses), urinary tract (e.g., cystitis, pyelonephritis), ears (otitis media), and uncomplicated gonorrhea.
- Pharmacological Classification: Antibiotic
- Mechanism of Action: Cefixime inhibits bacterial cell wall synthesis, while Dicloxacillin, a penicillinase-resistant penicillin, also disrupts bacterial cell wall formation, particularly in penicillinase-producing bacteria.
Alternate Names
There are no officially recognized alternate names for the combination of Cefixime + Dicloxacillin itself. However, the individual components have other names:
- Cefixime: Cefixime trihydrate
- Dicloxacillin: Dicloxacillin sodium
Brand names for the combination vary depending on the manufacturer and region. Some examples include Asert D, Modcef D, Mahacef XL 200 New, and Axim XL, though this is not an exhaustive list.
How It Works
Pharmacodynamics: Cefixime + Dicloxacillin exerts a bactericidal effect by disrupting the synthesis of the bacterial cell wall. Cefixime, a third-generation cephalosporin, binds to penicillin-binding proteins (PBPs) in the bacterial cell wall, inhibiting peptidoglycan synthesis. Dicloxacillin, a penicillinase-resistant penicillin, targets and inactivates PBPs, especially in bacteria that produce penicillinase, an enzyme that can break down some penicillins.
Pharmacokinetics:
- Absorption: Dicloxacillin’s absorption is reduced if taken after food, while Cefixime absorption is less affected.
- Metabolism: Cefixime undergoes minimal metabolism. Dicloxacillin is primarily metabolized in the liver.
- Elimination: Both Cefixime and Dicloxacillin are primarily eliminated via the kidneys. Dicloxacillin’s elimination half-life is approximately 0.7 hours, whereas Cefixime has a longer half-life.
Dosage
Dosage guidelines for Cefixime + Dicloxacillin vary depending on the infection, patient age, and renal function. Please note that these recommendations might change, and it’s important to stay updated on the latest clinical guidelines.
Standard Dosage
Adults: A common adult dose is one tablet of Cefixime 200mg + Dicloxacillin 500mg twice daily.
Children: The combination is generally recommended for adults and children 12 years and older. For children under 12, the combination’s safety and efficacy haven’t been fully established. Dosage adjustments are required based on the child’s age and weight. Consult specialized pediatric resources and dosing guidelines for specific recommendations.
Special Cases:
- Elderly Patients: Dose adjustments might be necessary based on renal function.
- Patients with Renal Impairment: Dosage reduction or increased dosing interval may be required.
- Patients with Hepatic Dysfunction: Caution is advised, and liver function should be monitored.
- Patients with Comorbid Conditions: Adjust dosage based on the specific comorbidity and its impact on drug metabolism and clearance.
Clinical Use Cases
Dosage in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, and emergencies should be determined based on the specific infection being treated and the patient’s overall condition. Standard dosing guidelines may apply, but adjustments are often necessary based on individual circumstances. Always consult updated therapeutic guidelines and expert advice for these specific situations.
Dosage Adjustments
Dose modifications should be considered for patients with renal or hepatic impairment, metabolic disorders, or genetic polymorphisms affecting drug metabolism. Consult appropriate resources for specific recommendations.
Side Effects
Common Side Effects:
- Nausea
- Vomiting
- Diarrhea
- Stomach pain
- Indigestion
- Headache
- Dizziness
- Vaginal itching
- Skin rash
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling, difficulty breathing)
- Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis)
- Liver dysfunction
- Seizures
- Abnormal blood test values (increased liver enzymes, eosinophilia)
Long-Term Effects: Long-term use can potentially lead to liver damage.
Contraindications
- Hypersensitivity to cephalosporins or penicillins
- History of kidney disease
- Severe liver disease
Drug Interactions
- Warfarin
- Furosemide
- Azithromycin
- Carbamazepine
- Probenecid
- Oral contraceptives
- Anticoagulants
- Antacids
- H2 blockers
- Uricosuric agents
- Live bacterial vaccines (e.g., typhoid, cholera)
Pregnancy and Breastfeeding
The safety of Cefixime + Dicloxacillin during pregnancy and breastfeeding hasn’t been fully established. Consult a doctor before use. Dicloxacillin is excreted in breast milk.
Drug Profile Summary
- Mechanism of Action: Inhibits bacterial cell wall synthesis.
- Side Effects: Nausea, vomiting, diarrhea, stomach pain, allergic reactions, liver dysfunction (rare).
- Contraindications: Hypersensitivity to cephalosporins or penicillins, kidney disease.
- Drug Interactions: Warfarin, probenecid, oral contraceptives.
- Pregnancy & Breastfeeding: Consult a doctor before use.
- Dosage: Adults: Cefixime 200mg + Dicloxacillin 500mg twice daily (adjust for renal impairment). Pediatric use: Consult specific guidelines.
- Monitoring Parameters: Renal function, liver function, signs of allergic reactions.
Popular Combinations
Cefixime + Dicloxacillin is itself a combination frequently used in clinical practice. Adding Lactobacillus as a probiotic is also a common practice.
Precautions
- General Precautions: Assess for allergies, renal/hepatic function before initiating therapy.
- Specific Populations: Use with caution in pregnant/breastfeeding women, children, and the elderly.
- Lifestyle Considerations: Alcohol interaction is unknown. Cefixime + Dicloxacillin might cause dizziness, so caution is advised when driving or operating machinery.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefixime + Dicloxacillin?
A: The usual adult dosage is Cefixime 200 mg + Dicloxacillin 500 mg twice daily. Dosage adjustments are necessary for children, the elderly, and patients with renal impairment.
Q2: What are the most common side effects?
A: Common side effects include nausea, vomiting, diarrhea, abdominal pain, and skin rash.
Q3: What are the serious side effects?
A: Severe allergic reactions, liver dysfunction, and severe skin reactions are rare but serious side effects.
Q4: Can I take this medication if I’m allergic to penicillin?
A: No, this medication is contraindicated in patients with penicillin allergy.
Q5: Can this medication be taken during pregnancy or breastfeeding?
A: Consult your doctor before use during pregnancy or breastfeeding. The safety in these situations is not fully established.
Q6: What other medications should be avoided while taking Cefixime + Dicloxacillin?
A: Avoid concomitant use with warfarin, probenecid, and oral contraceptives without consulting a doctor. Inform your physician about all other medications you are taking.
Q7: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is almost time for your next dose. Do not double the dose.
Q8: Can this medication be taken with food?
A: Dicloxacillin absorption is reduced when taken after food. Cefixime can be taken with or without food. Taking the combination with food might help reduce gastrointestinal upset.
Q9: What is the duration of treatment?
A: The duration of treatment depends on the type and severity of the infection and is determined by the physician. It’s crucial to complete the full course of treatment as prescribed.
