Cefixime + Lactobacillus

Usage

Cefixime + Lactobacillus is a combination medication primarily prescribed for bacterial infections, especially those of the respiratory tract (e.g., pharyngitis, tonsillitis, bronchitis, pneumonia), urinary tract (e.g., cystitis, pyelonephritis), and ear, nose, and throat infections. It is also used in some cases for typhoid fever. The addition of Lactobacillus aims to prevent antibiotic-associated diarrhea, a common side effect of Cefixime.

• Pharmacological Classification: Cefixime is a third-generation cephalosporin antibiotic, while Lactobacillus is a probiotic.

• Mechanism of Action: Cefixime exerts its antibacterial effect by inhibiting the synthesis of the bacterial cell wall, leading to bacterial cell death. Lactobacillus helps restore the balance of gut flora, which can be disrupted by antibiotic therapy. It produces lactic acid, creating an acidic environment that inhibits the growth of harmful bacteria.

Alternate Names

There are no widely recognized alternate names for this specific combination. However, Cefixime is sometimes referred to as its chemical name, and various strains of Lactobacillus are utilized (e.g., Lactobacillus acidophilus, Lactobacillus sporogenes).

• Brand Names: Several brand names exist for Cefixime in combination with different Lactobacillus strains and occasionally, other drugs. Brand names may vary regionally. Some examples include: Cefix Lb Dt, Takefix-LB and Flixime 200 LB.

How It Works

• Pharmacodynamics: Cefixime disrupts bacterial cell wall synthesis, resulting in bacterial cell lysis and death. Lactobacillus does not directly kill bacteria but competes with pathogenic bacteria for resources and adhesion sites in the gut, thus promoting a healthy gut microbiome.

• Pharmacokinetics: Cefixime is absorbed orally, reaching peak plasma concentrations in approximately 4 hours. Food does not significantly affect absorption. It is primarily excreted unchanged in the urine. The pharmacokinetics of Lactobacillus are complex, as it colonizes the gastrointestinal tract. Its survival and growth depend on various factors, including the specific strain and the gut environment.

• Mode of Action: Cefixime binds to penicillin-binding proteins (PBPs) in the bacterial cell wall, inhibiting the transpeptidation reaction essential for cell wall cross-linking. Lactobacillus produces lactic acid, which lowers the pH in the gut, creating an unfavorable environment for the growth of many pathogenic bacteria.

• Elimination Pathways: Cefixime is primarily excreted unchanged by the kidneys.

Dosage

Standard Dosage

Adults: The usual adult dosage of Cefixime is 200 mg twice daily or 400 mg once daily. The Lactobacillus component is typically dosed at 60 million spores twice daily.

Children: For children aged 6 months to 12 years and less than 50 kg, cefixime dosing should be individualized. The total daily dose is commonly calculated as 8 mg/kg/day. The dose can be given as single or divided into two doses. The dosage of Lactobacillus may vary depending on the brand.

Special Cases:

• Elderly Patients: Dose adjustments may be necessary in elderly patients with renal impairment.
• Patients with Renal Impairment: In patients with creatinine clearance below 20ml/min the dose is usually 200 mg once daily
• Patients with Hepatic Dysfunction: Cefixime is mainly excreted through the kidneys, hence no dosage adjustment is required.
• Patients with Comorbid Conditions: Caution is advised in patients with a history of colitis or other gastrointestinal diseases.

Clinical Use Cases

The combination of Cefixime + Lactobacillus is generally not used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary use is for treating common bacterial infections as an outpatient.

Dosage Adjustments

Dosages may be adjusted by healthcare professionals based on individual factors, such as the severity of the infection, the patient’s renal function, and their response to treatment.

Side Effects

Common Side Effects:

Diarrhea, nausea, vomiting, abdominal pain, indigestion, flatulence, headache, dizziness.

Rare but Serious Side Effects:

Allergic reactions (rash, itching, hives, swelling), severe diarrhea (possibly indicating Clostridium difficile infection), Stevens-Johnson syndrome.

Long-Term Effects: No specific long-term adverse effects have been directly associated with this combination.

Adverse Drug Reactions (ADR): Clinically significant ADRs include severe allergic reactions (anaphylaxis) and pseudomembranous colitis.

Contraindications

• Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
• History of severe colitis or gastrointestinal diseases.

Drug Interactions

• Anticoagulants (e.g., warfarin): Cefixime may enhance the anticoagulant effect.
• Probenecid: Can increase cefixime serum concentrations.
• Antacids: May decrease the absorption of cefixime.

Pregnancy and Breastfeeding

Cefixime use during pregnancy or lactation should be decided upon by balancing the potential risks against the expected clinical benefit. Consult a doctor before taking Cefixime + Lactobacillus if pregnant or breastfeeding.

Drug Profile Summary

• Mechanism of Action: Cefixime inhibits bacterial cell wall synthesis. Lactobacillus promotes a healthy gut microbiome.
• Side Effects: Diarrhea, nausea, vomiting, abdominal pain, allergic reactions.
• Contraindications: Hypersensitivity, severe colitis.
• Drug Interactions: Anticoagulants, probenecid, antacids.
• Pregnancy & Breastfeeding: Consult a physician before use.
• Dosage: Adults: 200-400 mg/day Cefixime. Pediatrics: individualized doses.
• Monitoring Parameters: Monitor for signs of infection resolution, allergic reactions, and gastrointestinal adverse effects.

Popular Combinations

Cefixime is sometimes combined with other antibiotics (e.g., azithromycin) for certain infections. Lactobacillus is often included to prevent antibiotic-associated diarrhea.

Precautions

• Assess renal function in elderly patients and those with renal impairment.
• Monitor for signs of allergic reactions or superinfections (e.g., C. difficile).
• Advise patients to complete the full course of antibiotics even if symptoms improve.

FAQs (Frequently Asked Questions)

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

A: Adults: 200-400 mg Cefixime/day, typically with 60 million spores of Lactobacillus twice daily. Pediatric dosages are weight-based.

Q2: Can this medication be taken with food?

A: Yes, Cefixime + Lactobacillus can be taken with or without food.

Q3: What are the common side effects?

A: Common side effects include diarrhea, nausea, vomiting, and abdominal pain.

Q4: Who should not take this medication?

A: Individuals with a known allergy to cephalosporins or Lactobacillus should not take this combination.

Q5: 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 the next dose. Do not double the dose.

Q6: How long should the medication be taken?

A: The duration of treatment depends on the infection type and severity, typically 7-14 days. Always complete the full course as prescribed.

Q7: Can I take this medication during pregnancy or breastfeeding?

A: Consult a physician before using this medication during pregnancy or breastfeeding.

Q8: Can Cefixime + Lactobacillus treat viral infections?

A: No, this medication is only effective against bacterial infections. It will not treat viral infections like the common cold or flu.

Q9: What if I experience severe diarrhea while taking this medication?

A: Severe diarrhea may be a sign of C. difficile infection. Contact your doctor immediately if you experience this.