Usage
Cefixime + Ofloxacin is a combination antibiotic used to treat bacterial infections, including typhoid fever and urinary tract infections (UTIs). Its pharmacological classifications are cephalosporin and fluoroquinolone antibiotics. Cefixime inhibits bacterial cell wall synthesis, while Ofloxacin blocks bacterial DNA replication, leading to bacterial death.
Alternate Names
This combination is often referred to as Cefixime and Ofloxacin. Brand names include Cefix-O, Extracef-Plus, Thenix Plus, and Cefexotime 0, among others. (Please note that brand names can vary regionally.)
How It Works
Pharmacodynamics: Cefixime interferes with bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs). Ofloxacin inhibits bacterial DNA gyrase and topoisomerase IV, enzymes crucial for DNA replication and repair.
Pharmacokinetics:
- Cefixime: Approximately 40-50% is absorbed orally, with higher absorption from suspension than tablets. It’s minimally metabolized and excreted primarily in urine, with a half-life of about 3 hours.
- Ofloxacin: Well-absorbed orally. It undergoes some hepatic metabolism and is eliminated through renal and hepatic routes.
Mode of Action: This combination acts synergistically. Cefixime weakens the bacterial cell wall, while Ofloxacin prevents DNA replication, ultimately leading to bacterial death.
Elimination Pathways: Cefixime is primarily excreted unchanged in the urine. Ofloxacin is excreted both renally and hepatically.
Dosage
Standard Dosage
Adults: One tablet of Cefixime 200 mg + Ofloxacin 200 mg twice daily for up to 14 days.
Children: This combination is generally not recommended for children and growing adolescents due to the risks associated with Ofloxacin. Specifically, Ofloxacin carries a risk of cartilage damage in developing children. While Cefixime may be used in children for certain infections (dosage based on weight), Ofloxacin should generally be avoided unless specifically prescribed by a doctor for exceptional cases where the benefits clearly outweigh the risks.
Special Cases:
- Elderly Patients: Dose adjustments are generally required only for renal or hepatic impairment.
- Patients with Renal Impairment: Cefixime dosage should not exceed 200 mg once daily if creatinine clearance is less than 20 mL/min. Ofloxacin dosage should also be reduced based on creatinine clearance.
- Patients with Hepatic Dysfunction: Ofloxacin dosage may need to be reduced in severe hepatic impairment.
- Patients with Comorbid Conditions: Caution is advised in patients with diabetes, epilepsy, myasthenia gravis, or a history of tendon disorders.
Clinical Use Cases
Dosage in specific clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations would follow the standard adult dosage guidelines or be adjusted based on patient-specific factors, including organ function, as described above. No source specifically addressed these scenarios.
Dosage Adjustments
Dose modifications are based on renal and hepatic function and other factors as outlined in the “Special Cases” section.
Side Effects
Common Side Effects:
Diarrhea, nausea, vomiting, abdominal pain, indigestion, headache, dizziness.
Rare but Serious Side Effects:
Allergic reactions (rash, itching, swelling), severe diarrhea (pseudomembranous colitis), tendonitis, tendon rupture, QT prolongation, seizures (especially in those with a history of epilepsy), peripheral neuropathy, and exacerbation of myasthenia gravis.
Long-Term Effects: Peripheral neuropathy and tendon issues can persist even after discontinuation.
Contraindications
Hypersensitivity to cefixime, ofloxacin, or other quinolones/cephalosporins. Epilepsy. History of tendon disorders related to fluoroquinolone use. Pregnancy. Breastfeeding. G6PD deficiency. Myasthenia gravis. Children and adolescents.
Drug Interactions
Antacids, sucralfate, H2 blockers (e.g., cimetidine), probenecid, warfarin, theophylline, NSAIDs, some antidiabetic agents, and some other antibiotics.
Pregnancy and Breastfeeding
This combination is contraindicated in both pregnancy and breastfeeding. Cefixime is pregnancy category B, meaning animal studies haven’t shown fetal harm, but adequate human studies are lacking. Ofloxacin is category C, meaning animal studies have shown some adverse effects, and its use is generally avoided in pregnancy and breastfeeding. Safer alternatives should be considered.
Drug Profile Summary
- Mechanism of Action: Cefixime: inhibits cell wall synthesis; Ofloxacin: inhibits DNA gyrase and topoisomerase IV.
- Side Effects: Common: diarrhea, nausea, abdominal pain. Serious: allergic reactions, tendon rupture, QT prolongation.
- Contraindications: Hypersensitivity, epilepsy, tendon disorders related to fluoroquinolones, pregnancy, breastfeeding, children and adolescents.
- Drug Interactions: Antacids, warfarin, theophylline, NSAIDs.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Adults: 200mg/200mg twice daily.
- Monitoring Parameters: Renal and liver function tests, signs of allergic reactions, tendon pain, cardiac rhythm (for QT prolongation).
Popular Combinations
No specific combinations are widely recognized for Cefixime + Ofloxacin beyond its combined formulation.
Precautions
Pre-existing medical conditions (renal/hepatic impairment, diabetes, epilepsy, myasthenia gravis) should be assessed. Alcohol should be avoided, and caution should be exercised when driving or operating machinery.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefixime + Ofloxacin?
A: The standard adult dose is 200 mg Cefixime + 200 mg Ofloxacin twice daily. Doses should be adjusted in renal or hepatic impairment.
Q2: Can children take Cefixime + Ofloxacin?
A: No, this combination is contraindicated for use in children and growing adolescents due to the risks associated with Ofloxacin affecting bone development.
Q3: What are the most common side effects?
A: The most common side effects include gastrointestinal issues like diarrhea, nausea, vomiting, and abdominal pain.
Q4: What are the serious side effects to watch for?
A: Serious side effects include allergic reactions, Clostridium difficile-associated diarrhea, tendonitis or tendon rupture, and QT prolongation.
Q5: Can I take this medication if I am pregnant or breastfeeding?
A: No, this medication is contraindicated in pregnancy and breastfeeding.
Q6: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. If it is close to the next scheduled dose, skip the missed dose and continue your regular dosing schedule.
Q7: What other medications should I avoid while taking this drug?
A: Avoid antacids, sucralfate, cimetidine, probenecid, warfarin, theophylline, NSAIDs, and some antidiabetic agents. Consult your doctor for a complete list.
Q8: How is Cefixime + Ofloxacin eliminated from the body?
A: Cefixime is eliminated predominantly through renal excretion, while Ofloxacin is eliminated through both renal and hepatic routes.
Q9: Is Cefixime + Ofloxacin effective against viral infections?
A: No, Cefixime + Ofloxacin is only effective against bacterial infections. It has no activity against viruses.
Q10: Are there any dietary restrictions while on Cefixime + Ofloxacin?
A: While no specific dietary restrictions are universally necessary, it’s advisable to take this medication with food to minimize gastrointestinal side effects. Dairy products like milk can slightly reduce absorption but are not absolutely contraindicated. It’s important to discuss any dietary concerns with your doctor.
