The Effect of Cefixime (CFIX) on the Intestinal Bacterial Flora

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Abstract
We studied the effect of a new oral cephem antibiotic cefixime (CFIX) on the intestinal bacterial flora in pediatric patients. The subjects in this study were 10 infants and children (5 boys and 5 girls) ranging in age from 7 months to 11 years and ranging in weight from 5.8 to 43.5 kg. CFIX was administered in granule form twice daily in doses of 3 mg/kg either for the treatment of infection or prophylaxis of infection in the patients with cardiac disease. Feces were collected before the treatment with CFIX began and on the 3rd to 7th days of treatment and on the 3rd to 7th days after ending the treatment. Bacteria in the feces was identified, and bacteria count per gram of feces and drug concentration in the feces were determined., β-Lactamase activity in the feces was also studied. Although the changes in the intestinal flora varied widely among the subjects, it was possible to roughly identify three groups: Group A, in which both aerobes and anaerobes were mainly unchanged, Group B, in which only Enterobacteriaceae such as E. coli and Klebsiella were reduced and Group C, in which both aerobes and anaerobes such as Enterobacteriaceae, Bifidobacterium, Eubacterium and Bacteroides were markedly reduced. Enterococcus was either unchanged or tended to increase in all 3 groups. CFIX was excreted at a high rate in the feces of the subjects with little or no, β-lactamase activity, and the bacterial flora showed great change in these subjects. Thus it is thought that differences in the sensitivity of the constituent intestinal bacteria to this drug as well as the level of β-lactamase activity in the feces are two highly significant clinical factors affecting the intestinal flora during the treatment with CFIX. There were 3 cases of diarrhea which could be attributed to the administration of CFIX, probably owing to the suppression of intestinal bacterial flora and also to the presence of C. difficile.

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