Cefixime + Dicloxacillin + Lactobacillus

Usage

Cefixime + Dicloxacillin + Lactobacillus is a combination medication primarily used to treat bacterial infections. It is effective against a wide range of bacterial infections, including those of the:

• Urinary tract
• Ears
• Nose
• Throat
• Chest
• Lungs
• Skin
• Soft tissues

Specifically, it is indicated for:

• Middle ear infections (otitis media)
• Tonsillitis and pharyngitis caused by Streptococcus pyogenes
• Acute bronchitis and exacerbations of chronic bronchitis
• Uncomplicated urinary tract infections
• Skin and soft tissue infections caused by Staphylococcus aureus

It does not work against viral infections.

Pharmacological Classification: This drug combines two antibiotics (Cefixime and Dicloxacillin) and a probiotic (Lactobacillus). Cefixime is a third-generation cephalosporin antibiotic, while Dicloxacillin is a penicillinase-resistant penicillin.

Mechanism of Action: Cefixime and Dicloxacillin interfere with the formation of the bacterial cell wall, which is crucial for bacterial survival. By disrupting cell wall synthesis, these antibiotics cause bacterial cell death. Lactobacillus helps restore the normal gut flora that may be disrupted by antibiotic use, thus minimizing side effects such as diarrhea.

Alternate Names

This combination drug itself doesn’t have a specific international nonproprietary name (INN). It is often referred to by its component drugs. Several brand names are available, including Zifi LBX, Lcef DX, and Ceftas CL.

How It Works

Pharmacodynamics: Cefixime and Dicloxacillin exert bactericidal effects by inhibiting bacterial cell wall synthesis. They bind to penicillin-binding proteins (PBPs) in the bacterial cell wall, disrupting its structural integrity. This ultimately leads to cell lysis and bacterial death. Lactobacillus does not have a direct effect on the infection but helps maintain gut health by restoring healthy bacteria.

Pharmacokinetics:

• Absorption: Cefixime is absorbed orally, with bioavailability around 40-50%. Dicloxacillin is also administered orally and is acid-stable, allowing for good absorption.
• Metabolism: Cefixime is minimally metabolized. Dicloxacillin undergoes some metabolism in the liver.
• Elimination: Cefixime is primarily excreted unchanged in the urine. Dicloxacillin is mainly excreted in the urine, with a small amount excreted in bile.

Receptor binding, enzyme inhibition, or neurotransmitter modulation: Cefixime and Dicloxacillin target PBPs involved in bacterial cell wall synthesis. Lactobacillus does not have specific receptor interactions.

Elimination pathways: Cefixime and Dicloxacillin are primarily eliminated through renal excretion.

Dosage

Standard Dosage

Adults: The standard dose is one tablet/capsule (typically containing 200 mg Cefixime, 500 mg Dicloxacillin, and a defined quantity of Lactobacillus spores, for instance 2.5 Billion Spores, or 90 Million Spores, as per the specific product) twice daily.

Children: This combination is generally not recommended for children under 10-12 years old, as safety and effectiveness have not been established. For older children, dosage must be determined by a physician, typically based on body weight (for cefixime component, children under 45kg: 8 mg/kg daily in a single dose or in two divided doses).

Special Cases:

• Elderly Patients: Dosage adjustments may be necessary based on renal function.
• Patients with Renal Impairment: Dose reduction is essential based on creatinine clearance.
• Patients with Hepatic Dysfunction: Caution is advised, and dosage adjustments might be needed.
• Patients with Comorbid Conditions: No specific guidance in source materials. Evaluate case by case.

Clinical Use Cases

Dosage for specific medical settings (Intubation, Surgical Procedures, Mechanical Ventilation, ICU Use, Emergency Situations) not provided in source material. Standard dosing or adjustments based on patient factors apply.

Dosage Adjustments

Dose modification is crucial based on renal/hepatic function.

Side Effects

Common Side Effects:

• Diarrhea
• Nausea
• Vomiting
• Abdominal pain
• Headache
• Indigestion
• Gas
• Vaginal itching
• Dizziness

Rare but Serious Side Effects:

• Severe allergic reactions
• Jaundice
• Seizures
• Kidney damage (with prolonged use)

Long-Term Effects: Potential liver and kidney damage (long term Dicloxacillin side effects).

Adverse Drug Reactions (ADR): Severe allergic reactions, liver or kidney damage.

Contraindications

• Hypersensitivity to cephalosporins, penicillins, or any component of the medication
• Severe renal impairment
• History of liver or kidney disease

Drug Interactions

• Warfarin (increased bleeding risk)
• Furosemide
• Azithromycin
• Steroids (dexamethasone, methylprednisolone, prednisone)
• Immunosuppressants (tacrolimus, ciclosporin)
• Antacids/H2 blockers (reduced Cefixime absorption)
• Probenecid (reduced Cefixime excretion)
• Oral contraceptives (Dicloxacillin may reduce efficacy)

Pregnancy and Breastfeeding

Consult a physician before use during pregnancy or breastfeeding. Safety has not been fully established. Limited data suggest potential risks. Some sources indicate caution is necessary. Dicloxacillin may impact the effectiveness of birth control pills.

Drug Profile Summary

• Mechanism of Action: Inhibits bacterial cell wall synthesis (Cefixime and Dicloxacillin), restores gut flora (Lactobacillus).
• Side Effects: See Side Effects section.
• Contraindications: See Contraindications section.
• Drug Interactions: See Drug Interactions section.
• Pregnancy & Breastfeeding: Consult a physician before use.
• Dosage: See Dosage section.
• Monitoring Parameters: Renal function, liver function, signs of allergic reactions, gastrointestinal symptoms.

Popular Combinations

This formulation itself is a common combination. Combining it with other antibiotics is generally not recommended without a specific clinical indication and expert guidance.

Precautions

• Assess for allergies to cephalosporins and penicillins before initiating therapy.
• Monitor renal and hepatic function.
• Exercise caution in patients with gastrointestinal disorders.
• Pregnant Women: Consult a physician.
• Breastfeeding Mothers: Consult a physician.
• Children & Elderly: Adjust dosage as needed.
• Avoid alcohol while taking this medication as the interaction is unknown.
• May cause dizziness; exercise caution when driving or operating machinery.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Cefixime + Dicloxacillin + Lactobacillus?

A: Adults: typically one tablet or capsule twice daily (200mg Cefixime, 500 mg Dicloxacillin, and specified Lactobacillus spore count, as per the specific product formulation). Pediatric: Not generally recommended for under 10-12 years. If needed for older children, physician should determine dose based on weight. Dosage adjustments are necessary for renal/hepatic impairment and elderly patients.

Q2: What infections is this combination effective against?

A: It’s effective against various bacterial infections, including urinary tract infections, ear infections, throat infections (like tonsillitis and pharyngitis caused by Streptococcus pyogenes), acute and chronic bronchitis, and skin and soft tissue infections caused by Staphylococcus aureus.

Q3: Can this combination be used in pregnant or breastfeeding women?

A: Consult a physician before use. Safety has not been fully established, and limited data suggest potential risks.

Q4: What are the common side effects?

A: Common side effects include diarrhea, nausea, vomiting, abdominal pain, headache, indigestion, gas, dizziness, and vaginal itching.

Q5: Are there any serious side effects I should be aware of?

A: While rare, serious side effects can include severe allergic reactions, jaundice, seizures, and potential liver or kidney damage with prolonged use. Seek immediate medical attention if these occur.

Q6: What are the major drug interactions?

A: This medication can interact with warfarin, furosemide, azithromycin, steroids, immunosuppressants, antacids, probenecid, and oral contraceptives. Disclose all medications you are taking to your physician.

Q7: Can this medication be used in children?

A: It is generally not recommended for children under 10-12 years old. If necessary for older children, the dosage must be adjusted by a physician based on their weight and renal function.

Q8: Should I avoid certain activities while taking this medication?

A: Cefixime + Dicloxacillin + Lactobacillus can cause dizziness in some patients. Therefore, it is advisable to avoid driving or operating heavy machinery if dizziness occurs. Avoid alcohol.

Q9: What should I do if I miss a dose?

A: Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.