Cefixime Indications and Limitations

Gonorrhea Treatment

• The CDC recommends ceftriaxone 250 mg IM plus azithromycin 1 g orally as first-line therapy for gonorrhea, with cefixime 400 mg orally plus azithromycin 1 g orally as an alternative only when ceftriaxone is unavailable, due to declining susceptibility and elevated MICs 1, 2
• Cefixime provides lower and less sustained bactericidal levels than ceftriaxone 125 mg IM, resulting in lower cure rates of 97.1-97.4% for urogenital/anorectal gonorrhea and 91% for pharyngeal gonorrhea 3, 2
• The CDC advises against using cefixime as monotherapy for gonorrhea due to resistance patterns, and recommends a mandatory test-of-cure at 1 week when cefixime is used 1, 2
• Local resistance patterns should be considered, as cefixime MIC elevations are more prevalent in Western U.S. and among men who have sex with men (MSM) populations 4
• The American College of Physicians and the CDC recommend avoiding cefixime for pharyngeal infections given its suboptimal 91% efficacy 2