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Short Course Cefixime to Prevent Irinotecan-Associated Diarrhea in Children With Solid Tumors: A Retrospective
Megan R Wright1, Shane J Cross1,2, Ted Morton1,2
1Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Pediatric Blood & Cancer
|July 23, 2026
Summary
A shortened 5-day cefixime regimen effectively prevents severe diarrhea in pediatric patients receiving irinotecan chemotherapy. This approach improved provider compliance without increasing irinotecan toxicity.
Area of Science:
- Pediatric Oncology
- Pharmacology
- Clinical Pharmacy
Background:
- Oral third-generation cephalosporins, like cefixime, are recommended for pediatric patients receiving irinotecan to mitigate diarrhea and enable higher irinotecan doses.
- The standard 10-day cefixime regimen presents significant compliance challenges in clinical practice.
- A multidisciplinary team implemented a standardized 5-day prophylactic cefixime regimen to address these logistical issues.
Purpose of the Study:
- To compare the incidence of severe diarrhea during the first irinotecan course before and after implementing a shortened 5-day cefixime prophylaxis regimen.
- To evaluate the impact of the shortened regimen on provider ordering compliance and the incidence of specific infections.
Main Methods:
- A single-center retrospective cohort study analyzed data from 85 pediatric patients (432 irinotecan courses) over 30 months.
- The study compared outcomes in the 12 months before and 18 months after the implementation of the 5-day cefixime regimen.
- Primary outcome: incidence of severe diarrhea; Secondary outcomes: provider compliance, antibiotic duration, and incidence of C. difficile or resistant gram-negative infections.
Main Results:
- Severe diarrhea incidence was similar between the pre- (5.4%) and post-implementation (6.2%) periods (p=0.7255).
- Provider ordering compliance significantly improved from 7.2% to 68.4% (p<0.0001) after the regimen change.
- Three patients developed C. difficile infections; no patients developed documented ceftriaxone-resistant gram-negative bacterial infections.
Conclusions:
- A 5-day prophylactic cefixime course, initiated with irinotecan, is safe and effective in pediatric patients.
- The shortened regimen significantly enhanced provider compliance with prophylactic antibiotic recommendations.
- The 5-day cefixime regimen did not result in increased irinotecan toxicity or severe diarrhea.
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