Tablet Presentation

Each film coated tablets contains:
Cefixime Trihyrdate IP                                         200 mg
Dicloxacillin Sodium {ER} IP     500 mg

Cefixime Trihydrate is an oral third generation cephalosporin antibiotic. Chemically, it is (6R,7R)-7-{[2-(2-amino-1,3- thiazol-4-yl)-2-(carboxymethoxyimino) acetyl]amino}-3- ethenyl-8-oxo-5-thia-1-azabicyclo-[4.2.0]oct-2-ene-2- carboxylic acid, clinically used in the treatment of susceptible infections including gonorrhoea, otitis media, pharyngitis, lower respiratory-tract infections such as bronchitis, and urinary-tract infections.

Dicloxacillin Sodium {ER} is a narrow-spectrum beta-lactam antibiotic of the penicillin class. It is used to treat infections caused by susceptible Gram-positive bacteria. It is active against beta-lactamase-producing organisms such as Staphylococcus aureus, which would otherwise be resistant to most penicillins.

Indication

Preferred Choice For:

• The combination is used for the treatment of adult patients with Upper, Lower respiratory tract infections and also skin and soft tissue infections.
• It is used to treat gonorrhea, tonsilitis, and pharyngitis.

Rationale of Combination

This combination Penetrates well into body tissues and fluids.This help in effective bacteridial action.Moreover, when pencicillinase -resistant penicillin(dicloxacillin) is also used,activity against B lactamse producing strains is enhanced. Thus in order to enhance the empiric profile of cefixime which has less potent activity against Gram +ve organisms, suc as Staphylococci,the addition of penicillianse resistant penicillin (Dicloxacillin) which provides added effect of Gram +ve coverage, with MIC90 values asw follows: S.aureus 0.1 mcg/ml; S.epidermis 0.1 mcg/ml;Str. pyogenes 0.1 mcg/ml; Str. pneumonniae 0.25 mcg/ml; N.gonorrheoae 0.1 mcg/ml converts the combination into a very broad spectrum antibiotic.

Advantages & Comparison

Advantages Over Plain Cefixime

Cefixime has a poor activity against S.aureus which preclude its use as a first choice in the treatment of soft tissue infections, toxic shock syndrome and food poisoning caused by S.aureus since dicloxacillin is highly effective for S.aureus CEFIXIME + DICLOXACILLIN combination enhanced use of this combination in skin infections, GI tract infections.

Advantages over Amoxycillin & Clavulanic Acid

Pseudomonas aeruginosa has become an important cause of infection, especially in patients with compromised host defense mechanisms.
It is a frequent cause of nosocomial infections such as pneumonia,urinary tract infections (UTIs), and bacteremia.
Pseudomonalinfections are compliccated and can be life threating.
Amoxicillin and clavulanic acid combination is ineffective for this strain which reduces its effectiveness as compared to cefixime and dicloxacillin combination efffective against this strain . Moreover M.I.C values for Amoxycillin and Clavulanate combination is 0.5mcg/ml for N.gonorrhea which implies this combination being active at higher dose than CEFIXIME and DICLOXACILLIN combination against same species which has M.I.C values of 0.1 mcg/ml for both species thus confirming CEFIXIME and DICLOXACILLIN superior effectiveness.

Advantages of Cefixime & Dicloxacillin over Azithromycin

AZITHROMYCIN is a bacteriostatic drug thus inhibits bacterial growth but CEFIXIME and DICLOXACILLIN combination is a bactericidal medication and kills bacteria S.PYOGENES ( Group A streptococci ) is a resistant to azithromycin. Azithromycin was inactive against Enterococci ( group D streptococci). S.Viridans is also resistant overall to azithromycin. But cefixime and dicloxacillin combination medication is very effective against S.PYOGENES with MIC value 0.1 mcg/ml .
GROUP A STREPTOCOCCI and S.viridans are responsible for throat infections, sinusitis,tonsillitis,pneumonia and scarlet fever.
Moreover AZITHROMYCIN MIC value against S.aureus is 0.25-1 mcg /ml however of cefixime and dicloxacillin is 0.1 mcg/ml thus this combination is more effective in skin infections caused by S.aureus.

Conclusions

CEFIXIME + DICLOXACILLIN is an efficacous and better treatment For Normal & Chronic Type of Bacterial Infections Otitis Media caused by Haemophilus influenzae( beta- lactamase +ve & -ve strains), Moraxella catarrhal is (most of which are beta- lactamase +ve) and Strep.Pyogenes. Pharyngitis and Tonsillits caused by Strep.Pyogenes. Acute Bronchitis and Acute Exacerbations of Chronic Bronchitis caused by Streptococcus pneumoniae and Haemophilus influenzae( beta - lactamase +ve & -ve strains). Beta Lactamase producing pathogens- In the treatment of infections with Staph.aureus and Bacteroides fragilis or with beta-lactamase producing H.influenzae and E.coli.
Abcess(pus formation)
Injuries
Osteomylitis
Skin and soft tissue infections
Ensures complete bacterial death
Medication with least side effects.