Usage
This combination is prescribed for bacterial and fungal infections, particularly where a combined bacterial and fungal infection is suspected or confirmed. Cefixime targets bacteria, while Fluconazole targets fungi.
- Cefixime: A third-generation cephalosporin antibiotic used to treat various bacterial infections, including urinary tract infections, ear infections, throat infections, and bronchitis.
- Fluconazole: A triazole antifungal used to treat a variety of fungal infections, such as vaginal yeast infections, oral thrush, and systemic candidiasis.
Pharmacological Classifications:
- Cefixime: Cephalosporin antibiotic
- Fluconazole: Triazole antifungal
Mechanism of Action:
- Cefixime: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins.
- Fluconazole: Inhibits fungal ergosterol synthesis by interfering with the enzyme 14-alpha-demethylase.
Alternate Names
This combination is not typically marketed under a single name. The components are commonly referred to by their generic names, Cefixime and Fluconazole. However, various brand names exist for each component individually:
Brand names
- Cefixime: Suprax, Zifi, Fixx
- Fluconazole: Diflucan, Trican
How It Works
Pharmacodynamics:
- Cefixime: Bactericidal action against susceptible bacteria.
- Fluconazole: Fungistatic or fungicidal action depending on the concentration and fungal species.
Pharmacokinetics:
- Cefixime: Orally administered, absorbed partially, hepatic metabolism negligible, excreted primarily via renal route and biliary excretion.
- Fluconazole: Well-absorbed orally, high bioavailability, widely distributed, hepatic metabolism minimal, renal excretion primarily as unchanged drug.
Mode of Action:
- Cefixime: Interferes with the transpeptidation reaction in bacterial cell wall synthesis, leading to cell lysis.
- Fluconazole: Inhibits fungal cytochrome P450 enzyme 14-alpha-demethylase, preventing ergosterol synthesis which is essential for fungal cell membrane integrity.
Elimination Pathways:
- Cefixime: Primarily renal excretion, some biliary excretion.
- Fluconazole: Primarily renal excretion as unchanged drug.
Dosage
Cefixime and Fluconazole are dosed independently based on the infection being treated and patient factors. The following are general guidelines:
Standard Dosage
Adults:
- Cefixime: Usually 400 mg once daily or 200 mg twice daily. Dose depends on the infection’s severity.
- Fluconazole: Dosage varies widely depending on the infection; from 150 mg single dose for vaginal candidiasis to 400 mg daily for more serious infections.
Children:
- Cefixime: 8 mg/kg once daily.
- Fluconazole: Dosage based on body weight and the specific infection. Consult pediatric dosing guidelines.
Special Cases:
- Elderly Patients: Cefixime: Dose adjustment may be needed in renal impairment. Fluconazole: Close monitoring and possible dose adjustments are needed, especially for renal impairment.
- Patients with Renal Impairment: Both drugs require dose adjustment based on creatinine clearance.
- Patients with Hepatic Dysfunction: Cefixime: Caution advised. Fluconazole: Monitor closely, dose adjustments needed rarely
- Patients with Comorbid Conditions: Individualized dosing required; consider disease interactions and drug metabolism impact
Clinical Use Cases
Dosing in specialized clinical settings is determined by the specific infection being treated and is not typically influenced by these clinical contexts.
- Intubation: No specific dose adjustments.
- Surgical Procedures: No specific dose adjustments.
- Mechanical Ventilation: No specific dose adjustments.
- Intensive Care Unit (ICU) Use: No specific dose adjustments.
- Emergency Situations: No specific dose adjustments.
Dosage Adjustments
Dose adjustments are based on renal function, hepatic function, and other patient-specific factors (age, comorbidities, drug interactions).
Side Effects
Common Side Effects
- Cefixime: Diarrhea, nausea, abdominal pain, headache, rash.
- Fluconazole: Headache, nausea, abdominal pain, diarrhea, rash, dizziness.
Rare but Serious Side Effects
- Cefixime: Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridium difficile-associated diarrhea, anaphylaxis.
- Fluconazole: Hepatotoxicity, QT prolongation, Stevens-Johnson syndrome, exfoliative skin disorders.
Long-Term Effects
- Cefixime: Antibiotic-associated colitis.
- Fluconazole: Rarely liver damage
Adverse Drug Reactions (ADR)
- Cefixime: Anaphylaxis, severe skin reactions.
- Fluconazole: Hepatotoxicity, serious skin reactions, QT prolongation.
Contraindications
- Cefixime: Hypersensitivity to cephalosporins.
- Fluconazole: Hypersensitivity to azoles, coadministration with terfenadine, cisapride, pimozide, quinidine, erythromycin.
Drug Interactions
- Cefixime: Probenecid, anticoagulants, antacids.
- Fluconazole: Numerous drug interactions; consult a comprehensive drug interaction resource. Key interactions include warfarin, some statins, some oral hypoglycemics, some immunosuppressants, cisapride.
Pregnancy and Breastfeeding
- Cefixime: Generally considered safe during pregnancy and breastfeeding.
- Fluconazole: Use with caution during pregnancy, especially in the first trimester, due to the potential risk of congenital malformations. Standard doses are generally considered acceptable during breastfeeding, but monitor the infant.
Drug Profile Summary
Refer to individual drug profiles for Cefixime and Fluconazole.
Popular Combinations
This combination is not a standard, frequently used combination.
Precautions
- Evaluate renal and hepatic function before and during treatment, particularly with prolonged use.
- Screen for drug allergies and potential drug interactions.
- Monitor for adverse drug reactions, especially hepatotoxicity and QT prolongation.
- Caution in patients with cardiac conditions.
- Advise patients to complete the full course of therapy.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefixime + Fluconazole?
A: Cefixime and Fluconazole are dosed separately based on the individual infection and patient factors. See the “Dosage” section for details.
Q2: What are the common side effects?
A: Common side effects include diarrhea, nausea, abdominal pain, headache, and rash.
Q3: Are there serious drug interactions?
A: Yes, numerous clinically significant interactions exist, especially with Fluconazole. Consult a drug interaction resource before co-prescribing.
Q4: Can this combination be used during pregnancy?
A: Cefixime is generally considered safe. Fluconazole should be used cautiously, especially at high doses. Consult the “Pregnancy and Breastfeeding” section.
Q5: Is it safe during breastfeeding?
A: Cefixime is generally safe. Standard doses of Fluconazole are acceptable, but monitor the infant.
Q6: What are the contraindications?
A: Hypersensitivity to cephalosporins or triazoles, severe liver or kidney impairment, certain concurrent medications.
Q7: How does this combination work?
A: Cefixime inhibits bacterial cell wall synthesis, while Fluconazole inhibits fungal ergosterol synthesis.
Q8: What are the key patient counseling points?
A: Advise patients on potential side effects, drug interactions, and the importance of completing the full course of therapy, even if symptoms improve.
Q9: What if a patient misses a dose?
A: Take the missed dose as soon as remembered unless it’s close to the time for the next dose. Do not double doses.
