Cefixime Treatment Guidelines

Gonorrhea Treatment

• The Centers for Disease Control and Prevention (CDC) recommends that cefixime is no longer used as routine first-line therapy for gonorrhea due to rising minimum inhibitory concentrations (MICs) and declining effectiveness, with cure rates of only 97.1-97.4% for urogenital/anorectal infections compared to 99.1% for ceftriaxone in adults 1, 2, 3, 4.
• Cefixime demonstrates limited efficacy for pharyngeal gonorrhea, with approximately 91% cure rate, making it unsuitable for this site 6.
• Cefixime may be used as an alternative for gonorrhea treatment when ceftriaxone is unavailable, in combination with azithromycin 1 g orally, with mandatory test-of-cure at 1 week 1, 6.

Resistance Patterns

• Resistance patterns are particularly concerning in the Western United States and among men who have sex with men (MSM), where elevated cefixime MICs increased from 0.2% in 2006 to 3.8% in 2011 4, 5.