Usage
Cefixime + Levofloxacin is a combination of two antibiotics used to treat bacterial infections. Cefixime is a cephalosporin antibiotic, and Levofloxacin is a fluoroquinolone antibiotic. This combination is prescribed for specific bacterial infections, including typhoid fever and urinary tract infections (UTIs). The combination is not typically used as a first-line treatment due to the risk of side effects associated with fluoroquinolones.
Alternate Names
There are no widely recognized alternate names for this specific combination drug itself. However, the individual components have various brand names depending on the manufacturer and the country. Some examples include:
- Cefixime: Suprax, Zifi
- Levofloxacin: Levaquin, Tavanic
How It Works
Cefixime inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins, ultimately leading to cell death.
Levofloxacin inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication and repair. This inhibition disrupts bacterial DNA synthesis and leads to cell death.
Pharmacokinetics:
- Cefixime: Administered orally. Absorption can be affected by food. Primarily excreted unchanged in urine.
- Levofloxacin: Administered orally or intravenously. Well absorbed and widely distributed in the body. Primarily excreted unchanged in urine, with a small amount metabolized in the liver.
Dosage
Standard Dosage
Adults:
The dosage varies based on the infection being treated. A common dosage for UTIs could involve Cefixime 200mg twice daily and Levofloxacin 250-500 mg once daily. The duration of treatment also varies based on the infection, typically ranging from 3 to 14 days.
Children:
Levofloxacin generally should be avoided in children due to the risk of musculoskeletal issues. Cefixime can be used in children, with dosage based on weight. For children over 6 months, Cefixime is typically dosed at 8 mg/kg/day either once daily or divided into two doses. For children weighing over 45kg, an adult dose of 400 mg once daily or 200 mg twice daily can be given.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary based on renal function.
- Patients with Renal Impairment: Dose reduction is necessary for both Cefixime and Levofloxacin.
- Patients with Hepatic Dysfunction: Cefixime dosage adjustment may be necessary. Levofloxacin is primarily renally eliminated, so dosage adjustments are less likely.
- Patients with Comorbid Conditions: Caution is advised in patients with diabetes, seizures, or myasthenia gravis.
Clinical Use Cases
This specific combination is not typically used in the clinical settings described (Intubation, Surgical Procedures, Mechanical Ventilation, ICU Use, Emergency Situations).
Dosage Adjustments
Dosage adjustments are based on renal function, hepatic function, and patient age. Creatinine clearance should be used to guide dose adjustments in renal impairment.
Side Effects
Common Side Effects
- Nausea
- Diarrhea
- Abdominal pain
- Headache
- Dizziness
Rare but Serious Side Effects
- Tendon rupture (Levofloxacin)
- Seizures (Levofloxacin)
- Peripheral neuropathy (Levofloxacin)
- Clostridium difficile - associated diarrhea (both drugs)
- Allergic reactions (both drugs)
- QT interval prolongation (Levofloxacin)
Long-Term Effects
Long-term use of Levofloxacin can increase the risk of tendon rupture and peripheral neuropathy.
Contraindications
- Hypersensitivity to cephalosporins or quinolones
- History of tendon rupture or inflammation with quinolones
- Myasthenia gravis (Levofloxacin)
- Pregnancy (Levofloxacin)
- Breastfeeding (Levofloxacin)
Drug Interactions
- Antacids, iron supplements, multivitamins
- Warfarin
- Theophylline
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
Pregnancy and Breastfeeding
Levofloxacin is contraindicated in pregnancy and breastfeeding. Cefixime use should be carefully evaluated in these situations, weighing the potential benefits against the risks.
Drug Profile Summary
- Mechanism of Action: Cefixime inhibits cell wall synthesis; Levofloxacin inhibits DNA gyrase and topoisomerase IV.
- Side Effects: Nausea, diarrhea, tendon rupture, seizures, peripheral neuropathy.
- Contraindications: Hypersensitivity, tendon issues, myasthenia gravis, pregnancy, breastfeeding.
- Drug Interactions: Antacids, warfarin, theophylline, NSAIDs.
- Pregnancy & Breastfeeding: Levofloxacin contraindicated; Cefixime use with caution.
- Dosage: Varies depending on the infection and patient factors.
- Monitoring Parameters: Renal function, liver function, signs of tendonitis or neuropathy.
Popular Combinations
This combination itself is not a “popular combination.” Typically, Levofloxacin or Cefixime would be used as monotherapy.
Precautions
- Evaluate renal and hepatic function before and during treatment.
- Monitor for signs of tendonitis, peripheral neuropathy, and C. difficile-associated diarrhea.
- Caution in patients with diabetes, seizures, or myasthenia gravis.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefixime + Levofloxacin?
A: The dosage varies based on the infection. Typical adult dosages could involve Cefixime 200 mg twice daily and Levofloxacin 250-500 mg once daily. Dose adjustments are required for renal impairment and other conditions. Levofloxacin should be avoided in children.
Q2: What are the most common side effects?
A: Nausea, diarrhea, and abdominal pain are common.
Q3: What are the serious side effects of Levofloxacin?
A: Tendon rupture, peripheral neuropathy, seizures, and QT prolongation are serious side effects of Levofloxacin.
Q4: Can Cefixime + Levofloxacin be used in pregnancy?
A: Levofloxacin is contraindicated in pregnancy. Cefixime use requires careful evaluation of the risk-benefit ratio.
Q5: Can Cefixime + Levofloxacin be used during breastfeeding?
A: Levofloxacin is contraindicated during breastfeeding. Cefixime use requires careful evaluation of the risk-benefit ratio.
Q6: What are the contraindications to using this combination?
A: Hypersensitivity to either drug, history of tendon rupture with quinolones, myasthenia gravis (for Levofloxacin), pregnancy and breastfeeding (for Levofloxacin).
Q7: What drug interactions should be considered?
A: Antacids, iron supplements, warfarin, theophylline, NSAIDs, and some other drugs can interact with this combination.
Q8: How is Cefixime + Levofloxacin eliminated from the body?
A: Both drugs are primarily excreted unchanged in urine.
Q9: How does this combination work against bacteria?
A: Cefixime inhibits cell wall synthesis while Levofloxacin inhibits bacterial DNA replication.
Q10: What should be monitored during treatment with this combination?
A: Monitor renal function, liver function (for Cefixime), and observe for signs of tendonitis, peripheral neuropathy, or other adverse effects.
