Axim 70ml Susp

Axim 70 ml Suspension (Cefuroxime Axetil 125 mg/5 ml) — Clinical Overview

What is Axim 70 ml Suspension?

Axim 70 ml Suspension is a paediatric oral antibiotic by ACI Limited, Bangladesh, providing cefuroxime axetil at 125 mg per 5 ml concentration after reconstitution. It is supplied as a dry powder that must be mixed with water before administration. Axim suspension is part of ACI's comprehensive Axim cefuroxime product range — which also includes 250 mg and 500 mg oral tablets and injectable cefuroxime sodium formulations — making it suitable for use across all age groups and hospital settings.

Cefuroxime axetil is a second-generation cephalosporin prodrug converted to active cefuroxime after absorption. It is bactericidal, killing susceptible organisms by inhibiting cell wall synthesis through penicillin-binding protein (PBP) blockade.

Why Oral Suspension vs. Tablets for Children?

Most children under 7–8 years of age cannot safely swallow tablets. The oral suspension form delivers the same active ingredient (cefuroxime axetil) in a liquid form that can be measured precisely for weight-based dosing. However, two clinically important differences apply:

• Lower bioavailability: Cefuroxime axetil suspension has measurably lower oral bioavailability than the tablet formulation at equivalent doses. Tablets and suspension are not bioequivalent and cannot be interchanged on a mg-for-mg basis.
• Food requirement: Like the tablet, the suspension should be taken with food or milk to enhance absorption and minimise gastrointestinal side effects.

Antimicrobial Coverage

Axim suspension covers the key organisms causing community-acquired paediatric infections:

• Gram-positive: Streptococcus pyogenes (Group A Strep — pharyngitis, impetigo), Streptococcus pneumoniae (otitis media, sinusitis), Staphylococcus aureus MSSA (skin infections)
• Gram-negative: Haemophilus influenzae including beta-lactamase-producing strains (otitis media, sinusitis), Moraxella catarrhalis (otitis media), E. coli and Klebsiella (UTI)
• Not covered: MRSA, Pseudomonas, Enterococcus, atypical organisms (Mycoplasma pneumoniae — commonly causes "walking pneumonia" in school-aged children and requires a macrolide like azithromycin, not cefuroxime)

Clinical Indications in Children

• Pharyngitis and tonsillitis: Group A Streptococcal throat infections — a 10-day course is mandatory to prevent acute rheumatic fever
• Acute otitis media: Standard second-line option when amoxicillin fails; dose escalated to 15 mg/kg BID
• Acute bacterial sinusitis
• Urinary tract infections (UTI): Children with E. coli or Klebsiella cystitis who are not systemically unwell
• Impetigo and infected skin wounds: Due to susceptible S. aureus or Streptococcus
• Early Lyme disease: Paediatric dose 15 mg/kg twice daily (max 250 mg twice daily) for 20 days

Diabetes in Children — Infection Management

Children with Type 1 diabetes mellitus are particularly vulnerable to recurrent bacterial infections. Parents and caregivers should be aware:

• UTIs in diabetic girls: Glycosuria from hyperglycaemia promotes bacterial growth in urine. Recurrent UTIs in diabetic girls are common and may require urine cultures before prescribing to detect resistant organisms (ESBL-producing E. coli).
• Skin infections in diabetic children: Poor wound healing and impaired immune function increase susceptibility to impetigo and cellulitis. Early antibiotic treatment with cefuroxime suspension can prevent spread.
• Blood glucose monitoring during infection: Any acute bacterial infection can precipitate diabetic ketoacidosis (DKA) in Type 1 diabetic children. Parents should check blood glucose every 2–4 hours and ketones every 4 hours during any febrile illness and antibiotic course.
• Suspension sugar content: Some antibiotic suspensions contain sucrose. Check the product leaflet for sugar content in Axim suspension and discuss with your paediatric diabetologist if tight glycaemic control is a concern.

Reconstitution and Storage

1. Tap bottle gently to loosen powder at the base
2. Add cooled boiled water in two portions (total volume specified on label, ~37 ml for a 70 ml bottle)
3. Cap the bottle and shake vigorously after each water addition
4. Ensure no powder remains at the bottom — shake until a uniform white suspension forms
5. Write reconstitution date on the label

Storage after reconstitution: Refrigerate at 2–8°C. Do NOT freeze. Shake well before each dose. Discard after 10 days even if medicine remains — efficacy cannot be guaranteed after this period.

Paediatric Dosing Guide

• General infections (pharyngitis, UTI, skin): 10 mg/kg twice daily (max 125 mg = 5 ml twice daily)
• Otitis media / Lyme disease: 15 mg/kg twice daily (max 250 mg = 10 ml twice daily)
• Treatment duration: Pharyngitis 10 days; otitis media 7–10 days; UTI 7–14 days; Lyme disease 20 days

Measure with an oral syringe or calibrated spoon. Do not use household teaspoons. Give with food or milk.

Drug Interactions

• Antacids / H2-blockers: Reduce cefuroxime absorption — avoid co-administration; give cefuroxime with food instead
• Probenecid: Increases plasma cefuroxime levels (uncommon in children)
• Live bacterial vaccines: Antibiotics may impair efficacy of oral typhoid vaccine and BCG — avoid vaccination during treatment

Side Effects

• Common: Diarrhoea (more frequent with suspension than tablets due to lower gut absorption and greater colonic drug exposure), nausea, vomiting, rash, nappy rash in infants
• Uncommon: Elevated liver enzymes, eosinophilia
• Rare: Anaphylaxis, Stevens-Johnson syndrome, C. difficile colitis

Contraindications

• Known hypersensitivity to cefuroxime or other cephalosporins
• Severe immediate penicillin allergy (cross-reactivity ~1–2%)

Frequently Asked Questions (FAQ)