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Components:
Cefixime
Method of action:
Antibacterial Broad Spectrum (Bactericidal), Bactericidal
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Medically reviewed by Oliinyk Elizabeth Ivanovna, Pharmacy. Last updated on 2019.11.15

Name of the medicinal product

Acufix

Qualitative and quantitative composition

Cefixime

Therapeutic indications

The information provided in Therapeutic indications of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Therapeutic indications in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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Acufix is an orally active cephalosporin antibiotic which has marked in vitro bactericidal activity against a wide variety of Gram-positive and Gram-negative organisms.

It is indicated for the treatment of the following acute infections when caused by susceptible micro-organisms:

Upper Respiratory Tract Infections (URTI): e.g. otitis media; and other URTI where the causative organism is known or suspected to be resistant to other commonly used antibiotics, or where treatment failure may carry significant risk.

Lower Respiratory Tract Infection: e.g. bronchitis.

Urinary Tract Infections: e.g. cystitis, cystourethritis, uncomplicated pyelonephritis.

Clinical efficacy has been demonstrated in infections caused by commonly occuring pathogens including Streptococcus pneumoniae, Streptococcus pyogenes, Escherichia coli, Proteus mirabilis, Kliebsiella species, Haemophilus influenzae (beta-lactamase positive and negative), Branhamella catarrhalis (beta-lactamase positive and negative) and Enterobacter species. Acufix is highly stable in the presence of beta-lactamase enzymes.

Most strains of enterococci (Streptococcus faecalis, group D Streptococci) and Staphylococci (including coagulase positive and negative strains and meticillin-resistant strains) are resistant to Acufix. In addition, most strains of Pseudomonas, Bacteriodes fragalis, Listeria monocytogenes and Clostridia are resistant to Acufix.

Dosage (Posology) and method of administration

The information provided in Dosage (Posology) and method of administration of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Dosage (Posology) and method of administration in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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Absorption of Acufix is not significantly modified by the presence of food. The usual course of treatment is 7 days. This may be continued for up to 14 days if required.

Adults and Children over 10 Years: The recommended adult dosage is 200-400 mg daily according to the severity of infection, given either as a single dose or in two divided doses.

The Elderly: Elderly patients may be given the same dose as recommended for adults. Renal function should be assessed and dosage should be adjusted in severe renal impairment (See “Dosage in Renal Impairment”).

Children (Use Paediatric Oral Suspension): The recommended dosage for children is 8 mg/kg/day administered as a single dose or in two divided doses. As a general guide for prescribing in children the following daily doses in terms of volume of Paediatric Oral Suspension are suggested:

6 months up to 1 year:

Children 1-4 years:

Children 5-10 years:

3.75 ml daily

5 ml daily

10 ml daily

Children weighing more than 50 kg or older than 10 years should be treated with the recommended adult dose (200 - 400 mg daily depending on the severity of infection).

The safety and efficacy of cefixime has not been established in children less than 6 months.

Dosage In Renal Impairment: Acufix may be administered in the presence of impaired renal function. Normal dose and schedule may be given in patients with creatinine clearances of 20 ml/min or greater. In patients whose creatinine clearance is less than 20 ml/min, it is recommended that a dose of 200 mg once daily should not be exceeded. The dose and regimen for patients who are maintained on chronic ambulatory peritoneal dialysis or haemodialysis should follow the same recommendation as that for patients with creatinine clearances of less than 20 ml/min.

Contraindications

The information provided in Contraindications of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Contraindications in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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Patients with known hypersensitivity to cephalosporin antibiotics or any of the other components of the product.

Special warnings and precautions for use

The information provided in Special warnings and precautions for use of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Special warnings and precautions for use in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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Encephalopathy

Beta-lactams, including cefixime, predispose the patient to encephalopathy risk (which may include convulsions, confusion, impairment of consciousness, movement disorders), particularly in case of overdose or renal impairment.

Severe cutaneous adverse reactions

Severe cutaneous adverse reactions such as toxic epidermal necrolysis, Stevens-Johnson syndrome and drug rash with eosinophilia and systemic symptoms (DRESS) have been reported in some patients on cefixime. When severe cutaneous adverse reactions occur, cefixime should be discontinued and appropriate therapy and/or measures should be taken.

Acufix should be given with caution to patients who have shown hypersensitivity to other drugs.

Hypersensitivity to penicillins

As with other cephalosporins, cefixime should be given with caution to patients with a history of hypersensitivity to penicillin, as there is some evidence of partial cross-allergenicity between the penicillins and cephalosporins.

Patients have had severe reactions (including anaphylaxis) to both classes of drugs. If an allergic effect occurs with Acufix, the drug should be discontinued and the patient treated with appropriate agents if necessary.

Haemolytic anaemia

Drug-induced haemolytic anaemia, including severe cases with a fatal outcome, has been described for cephalosporins (as a class). The recurrence of haemolytic anaemia after re-administration of cephalosporins in a patient with a history of cephalosporin (including cefixime) -associated haemolytic anaemia has also been reported.

Renal failure acute

As with other cephalosporins, cefixime may cause acute renal failure including tubulointerstitial nephritis as an underlying pathological condition. When acute renal failure occurs, cefixime should be discontinued and appropriate therapy and/or measures should be taken.

Renal impairment

).

Paediatric use

Safety of cefixime in premature or newborn infant has not been established.

Treatment with broad spectrum antibiotics alters the normal flora of the colon and may permit overgrowth of clostridia. Studies indicate that a toxin produced by Clostridium difficile is a primary cause of antibiotic-associated diarrhoea. Pseudomembranous colitis is associated with the use of broad-spectrum antibiotics (including macrolides, semi-synthetic penicillins, lincosamides and cephalosporins); it is therefore important to consider its diagnosis in patients who develop diarrhoea in association with the use of antibiotics. Symptoms of pseudomembranous colitis may occur during or after antibiotic treatment.

Management of pseudomembranous colitis should include sigmoidoscopy, appropriate bacteriologic studies, fluids, electrolytes and protein supplementation. If the colitis does not improve after the drug has been discontinued, or if the symptoms are severe, oral vancomycin is the drug of choice for antibiotic-associated pseudomembranous colitis produced by

C. difficile. Other causes of colitis should be excluded.

Effects on ability to drive and use machines

The information provided in Effects on ability to drive and use machines of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Effects on ability to drive and use machines in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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In the case of side effects such as encephalopathy (which may include convulsion, confusion, impairment of consciousness, movement disorders), the patient should not operate machines or drive a vehicle.

Undesirable effects

The information provided in Undesirable effects of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Undesirable effects in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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Acufix is generally well tolerated. The majority of adverse reactions observed in clinical trials were mild and self-limiting in nature.

The following adverse reaction (Preferred term# or equivalent) will be considered listed:

Blood and lymphatic system disorders:

Eosinophilia

Hypereosinophilia

Agranulocytosis

Leucopenia

Neutropenia

Granulocytopenia

Haemolytic anaemia

Thrombocytopenia

Thrombocytosis

Gastrointestinal:

Abdominal pain

Diarrhoea*

Dyspepsia

Nausea

Vomiting

Flatulance

Hepatobiliary disorders:

Jaundice

Infections and infestations:

Pseudomembranous colitis

Investigations:

Aspartate aminotransferase increased

Alanine aminotransferase increased

Blood bilirubin increased

Blood urea increased

Blood creatinine increased

Nervous system disorders:

Dizziness

Headache

Cases of convulsions have been reported with cephalosporins including cefixime (frequency not known)**

Beta-lactams, including cefixime, predispose the patient to encephalopathy risk (which may include convulsions, confusion, impairment of consciousness, movement disorders), particularly in case of overdose or renal impairment (frequency not known)**

Respiratory, thoracic and mediastinal disorders:

Dyspnoea

Renal and urinary disorders:

Renal failure acute including tubulointerstitial nephritis as an underlying pathological condition

Immune System disorders, administrative site conditions, skin and subcutaneous tissue disorders:

Anaphylactic reaction

Serum sickness-like reaction

Drug rash with eaosinophilia and systemic symptoms (DRESS)

Pruritus

Rash

Drug Fever

Arthralgia

Erythema multiforme

Stevens-Johnson syndrome

Toxic epidermal necrolysis

Angio-oedema

Urticaria

Pyrexia

Face oedema

Genital pruritus

Vaginitis

The above mentioned listed adverse reactions have been observed during clinical studies and/or during marketed use.

# Preferred term in MedDRA (v.14.0)

*Diarrhoea has been more commonly associated with higher doses. Some cases of moderate to severe diarrhoea have been reported; this has occasionally warranted cessation of therapy. Acufix should be discontinued if marked diarrhoea occurs

** Cannot be estimated from available data

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Overdose

The information provided in Overdose of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Overdose in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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There is a risk of encephalopathy in cases of administration of beta-lactam antibiotics, including cefixime, particularly in case of overdose or renal impairment.

Adverse reactions seen at dose levels up to 2 g Acufix in normal subjects did not differ from the profile seen in patients treated at the recommended doses. Cefixime is not removed from the circulation in significant quantities by dialysis.

No specific antidote exists. General supportive measures are recommended

Pharmacodynamic properties

The information provided in Pharmacodynamic properties of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Pharmacodynamic properties in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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Cefixime is an oral third generation cephalosporin which has marked in vitro bactericidal activity against a wide variety of Gram-positive and Gram-negative organisms.

Clinical efficacy has been demonstrated in infections caused by commonly occurring pathogens including Streptococcus pneumoniae, Streptococcus pyogenes, Escherichia coli, Proteus mirabilis, Klebsiella species, Haemophilus influenzae (beta-lactamase positive and negative), Branhamella catarrhalis (beta-lactamase positive and negative) and Enterobacter species. It is highly stable in the presence of beta-lactamase enzymes.

Most strains of enterococci (Streptococcus faecalis, group D Streptococci) and Staphylococci (including coagulase positive and negative strains and meticillin-resistant strains) are resistant to cefixime. In addition, most strains of Pseudomonas, Bacteroides fragilis, Listeria monocytogenes and Clostridia are resistant to cefixime.

Pharmacokinetic properties

The information provided in Pharmacokinetic properties of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Pharmacokinetic properties in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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The absolute oral bioavailability of cefixime is in the range of 22-54%. Absorption is not significantly modified by the presence of food. Cefixime may therefore be given without regard to meals.

From in vitro studies, serum or urine concentrations of 1 mcg/mL or greater were considered to be adequate for most common pathogens against which cefixime is active. Typically, the peak serum levels following the recommended adult or paediatric doses are between 1.5 and 3 mcg/mL. Little or no accumulation of cefixime occurs following multiple dosing.

The pharmacokinetics of cefixime in healthy elderly (age > 64 years) and young volunteers (11-35) compared the administration of 400 mg doses once daily for 5 days. Mean Cmax and AUC values were slightly greater in the elderly. Elderly patients may be given the same dose as the general population.

Cefixime is predominantly eliminated as unchanged drug in the urine. Glomerular filtration is considered the predominant mechanism. Metabolites of cefixime have not been isolated from human serum or urine.

Serum protein binding is well characterised for human and animal sera; cefixime is almost exclusively bound to the albumin fraction, the mean free fraction being approximately 30%. Protein binding of cefixime is only concentration dependent in human serum at very high concentrations which are not seen following clinical dosing.

Transfer of 14C-labelled cefixime from lactating rats to their nursing offspring through breast milk was quantitatively small (approximately 1.5% of the mothers' body content of cefixime in the pup). No data are available on secretion of cefixime in human breast milk. Placetal transfer of cefixime was small in pregnant rats dosed with labelled cefixime.

Preclinical safety data

The information provided in Preclinical safety data of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Preclinical safety data in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the Summary of Product Characteristics.

Incompatibilities

The information provided in Incompatibilities of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Incompatibilities in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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None.

Special precautions for disposal and other handling

The information provided in Special precautions for disposal and other handling of Acufix is based on data of another medicine with exactly the same composition as the Acufix of the medicine (Cefixime). Be careful and be sure to specify the information on the section Special precautions for disposal and other handling in the instructions to the drug Acufix directly from the package or from the pharmacist at the pharmacy.
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None.

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