Cefixime

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Cefixime is a cephalosporin antibiotic used in the laboratory setting. It is a broad-spectrum antibiotic effective against a variety of bacterial infections. Cefixime functions by inhibiting cell wall synthesis in bacteria, leading to cell lysis and death.

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Cefixime Tellurite Selective Supplement (2 citations)

11 protocols using cefixime

Antibiotic Resistance Profiling of Isolates

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Antibiotic resistance profiles were obtained from 166 isolates. A standardized amount was inoculated (standard 0.5 of McFarland) and antimicrobial susceptibility testing was performed by the disk diffusion method on Mueller–Hinton (MH) agar (Difco Laboratories, Detroit, MI, USA) using interpretative criteria of the Clinical and Laboratory Standard Institute (CLSI) [34 ]. The following antimicrobials were used: trimethoprim/sulfametoxazol (SXT, 23.75 μg + 1.25 μg), gentamicin (GEN, 10 μg), ciprofloxacin (CIP, 5 μg), ceftazidime (CAZ, 30 μg), cefoxitin (FOX, 30 μg), cefotaxime (CTX, 30 μg), meropenem (MEM, 10 μg), piperacillin/tazobactam (TZP, 40 μg), and cefixime (CFM, 5 μg) (Oxoid Ltd., Hampshire, United Kingdom). ESBL-positive isolates were identified by using the double-disk synergy test with third-generation cephalosporins (cefotaxime, ceftazidime, and cefixime) alone and with clavulanic acid. Quality control was carried out using standard strains of Escherichia coli (ATCC 25922) and Pseudomonas aeruginosa (ATCC 27953). Intermediate susceptibility to each antibiotic was considered to be resistant.
According to the definitions proposed by Magiorakos et al., resistance to three or more antibiotic classes was defined as multidrug resistant (MDR) [35 (link)].

Chavez M.V., Caicedo L.D, & Castillo J.E. (2019). Occurrence of β-Lactamase-Producing Gram-Negative Bacterial Isolates in Water Sources in Cali City, Colombia. International Journal of Microbiology, 2019, 1375060.

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Antimicrobial Resistance Profiling of MRSA

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The pattern of antimicrobial resistance was studied using the simple disk diffusion technique. The Mueller–Hinton agar (Merck, Germany) medium was used for this purpose. Antibiotic resistance of the MRSA strains against 18 commonly used antibiotics was determined using the instructions provided by the Clinical and Laboratory Standards Institute guidelines (18 ). Susceptibility of MRSA isolates was tested against ampicillin (10 µg/disk), gentamycin (10 µg/disk), lincomycin (2 µg/disk), cephalothin (30 µg/disk), imipenem (30 µg/disk), tetracycline (30 µg/disk), vancomycin (5 µg/disk), ciprofloxacin (5 µg/disk), norfloxacin (30 µg/disk), cotrimoxazole (30 µg/disk), clindamycin (2 µg/disk), trimethoprim-sulfamethoxazole (25 μg/disk), penicillin (10 µg/disk), oxacillin (1 µg/disk), erythromycin (15 µg/disk), azithromycin (15 µg/disk), ceftriaxone (30 µg/disk) and cefixime (5 µg/disk) antibiotic agents (Oxoid, UK). The plates containing the discs were allowed to stand for at least 30 minutes before incubation at 35°C for 24 hours. The diameter of the zone of inhibition produced by each antibiotic disc was measured and interpreted using the CLSI zone diameter interpretative standards (18 ). Staphylococcus aureus ATCC 25923 and Escherichia coli (E. coli) ATCC 25922 were used as quality control organisms in antimicrobial susceptibility determination.

Dormanesh B., Siroosbakhat S., Khodaverdi Darian E, & Afsharkhas L. (2015). Methicillin-Resistant Staphylococcus aureus Isolated From Various Types of Hospital Infections in Pediatrics: Panton-Valentine Leukocidin, Staphylococcal Chromosomal Cassette mec SCCmec Phenotypes and Antibiotic Resistance Properties. Jundishapur Journal of Microbiology, 8(11), e11341.

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Antimicrobial Susceptibility of ESBL-Producing Isolates

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Antimicrobial susceptibility tests of the three ESBL-producing isolates and seven non-ESBL-producing isolates were evaluated using the disk diffusion method to Piperacillin 100 μg (PIP), Moxalactam 30 μg (MOX), Ceftazidime 30 μg (CAZ), Cefixime 5 μg (CFM), Cefepime 30 μg (FEP), Cefotaxime 30 μg (CTX), Cephalexin 30 μg (CL), Caphazolin 30 μg (CZ), Ceftriaxone 30 μg (CRO), Cefoxitin 30 μg (FOX), Piperacillin/Tazobactam 100/10 μg (TZP), Cefuroxime 30 μg (CXM), Cefaclor 30 μg (CEC), Ampicillin/Sulbactam 10/10 μg (SAM), Cefoperazone 75 μg (CFP), Ceftizoxime 30 μg (ZOX), Aztreonam 30 μg (ATM), Meropenem 10 μg (MEM), Imipenem 10 μg (IPM), Kanamycin 30 μg (K), Streptomycin 10 μg (S), Ofloxacin 5 μg (OFX), Norfloxacin 10 μg (NOR), CiprOfloxacin 5 μg (CIP); Gatifloxacin 5 μg (GTX), Chloramphenicol 30 μg (C), Azithromycin 15 μg (AZM), Doxycycline 30 μg (TE), Minocycline 30 μg (MH), Compound Sulfamethoxazole 23.75/1.25 μg (SMZ), and Trimethoprim 5 μg (TMP) (Oxoid, Basingstoke, United Kingdom). The results were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) breakpoints. Escherichia coli ATCC 25,922 was used as a control for antimicrobial susceptibility testing.

Su X., Yan X., Li Y., Zhang D., Li L., Geng Y., Su F., Yue C., Hou R, & Liu S. (2022). Identification of extended-spectrum beta-lactamase (CTX-M)-producing Klebsiella pneumoniae belonging to ST37, ST290, and ST2640 in captive giant pandas. BMC Veterinary Research, 18, 186.

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Antibiotic Resistance Testing of Flavonoids

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The antibiotic discs included amoxicillin (AMO; 25 μg), ampicillin (AMP; 10 μg), ceftriaxone (CET; 30 μg), cefixime (CEF; 5 μg), cephradine (CEPH; 30 μg), erythromycin (ERY; 15 μg), vancomycin (VAN; 30 μg), methicillin (ME; 10 μg), ciprofloxacin (CIP; 5 μg), levolfloxacin (LEV; 5 μg), sulfamethaxozole-trimethoprim (S-T; 25 μg) and imipenem (IMP; 10 μg) were from Oxoid, UK while blank discs were purchased from Himedia, India. Test flavonoids; rutin, morin, and quercetin were purchased from Sigma-Aldrich, UK. Stock solutions of flavonoids morin, rutin, and quercetin were made at concentrations of 50 g/l, 6 g/l, and 10 g/l respectively, using ethanol. Bacterial culturing medias such as nutrient agar (NA; CM0003B), muller hinton agar (MHA; CM0337B), nutrient broth (N.B; CM0001B) and muller hinton broth (MHB; CM0405B) were from Oxoid, UK. mannitol salt agar (MSA; LAB007) was obtained from Lab M Limited, UK.

Amin M.U., Khurram M., Khattak B, & Khan J. (2015). Antibiotic additive and synergistic action of rutin, morin and quercetin against methicillin resistant Staphylococcus aureus. BMC Complementary and Alternative Medicine, 15, 59.

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Antibiotic Susceptibility Profiling of Colistin-Resistant Strains

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Colistin resistant strains were tested for their susceptibility to other antimicrobials following the disc diffusion method as described by Bauer et al. [19 (link)] using commercially available antibiotic discs. Eighteen commonly used antibiotics (Oxoid, UK) tested in this study include: ceftriaxone (CRO 30 µg), cephalothin (KF 30 µg), cefipime (FEP 30 µg), cefixime (CFM 5 µg), fosfomycin (FOS 50 µg), mecillinam ( MEL 25 µg), tetracycline (TE 30 µg), sulphamethoxazole-trimethoprium (SXT 25 µg), levofloxacin (LEV 5 µg), erythromycin (E 15 µg), azithromycin (AZM 15 µg), imipenem (IPM 10 µg), ampicillin (AMP 10 µg), nalidixic Acid (NA 30 µg), ciprofloxacin (CIP 5 µg), gentamicin (CN 10 µg), chloramphenicol (C 30 µg), and aztreonam (ATM 30 µg). The resistance or susceptibility profiles of the isolates were determined by measuring the inhibitory zone and comparing it with an interpretative chart to determine sensitivity to the antibiotics according to Clinical and Laboratory Standards Institute guideline [20 ]. E. coli ATCC 25922 was used as a positive control.

Johura F.T., Tasnim J., Barman I., Biswas S.R., Jubyda F.T., Sultana M., George C.M., Camilli A., Seed K.D., Ahmed N, & Alam M. (2020). Colistin-resistant Escherichia coli carrying mcr-1 in food, water, hand rinse, and healthy human gut in Bangladesh. Gut Pathogens, 12, 5.

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ESBL Detection Methods and CTX-M-15 Characterization

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ESBLs were detected as previously described [27 (link)] using the disc approximation and double-disc synergy methods and confirmed with cefotaxime and ceftazidime E-test ESBL strips (AB Biodisk, Biomerieux-diagnostics, Durham, NC, USA). For the disc approximation test, clavulanate diffusion from an amoxicillin–clavulanate (AMC30) disc was used to test for synergy with cefotaxime, ceftazidime, cefuroxime, cefepime and cefixime (Oxoid) as described previously [28 (link)]. For the double-disc synergy test, a ceftazidime disc (30 μg) was placed 30 mm away from a disc containing amoxicillin–clavulanate (60/10 μg). ESBL production was considered positive when an enhanced zone of inhibition was visible between the β-lactam and β-lactamase inhibitor-containing discs. For the E-test, ESBL strips containing ceftazidime and ceftazidime–clavulanate and strips containing cefotaxime and cefotaxime–clavulanate were used to determine the MIC ratio according to the manufacturer’s instructions (AB Biodisk, Biomerieux-diagnostics, Durham, NC, USA). Cultures were incubated aerobically at 37°C for 18–24 h. CTX-M-15 β-lactamase enzyme displays a catalytic activity toward ceftazidime.

Dashti A.A., Vali L., El-Shazly S, & Jadaon M.M. (2014). The characterization and antibiotic resistance profiles of clinical Escherichia coli O25b-B2-ST131 isolates in Kuwait. BMC Microbiology, 14, 214.

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ESBL Detection using Disc Approximation and E-test

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ESBLs were detected as previously described using the disc approximation and double-disc synergy methods and confirmed with cefotaxime and ceftazidime E-test ESBL strips (AB Biodisk, Biomerieux-diagnostics, Durham, NC, USA) [2 (link)]. For the disc approximation test, clavulanate diffusion from an amoxicillin–clavulanate (AMC30) disc was used to test for synergy with cefotaxime, ceftazidime, cefuroxime, cefepime and cefixime (Oxoid) as described previously [15 (link)]. For the double-disc synergy test, a ceftazidime disc (30 μg) was placed 30 mm away from a disc containing amoxicillin–clavulanate (60/10 μg). ESBL production was considered positive when an enhanced zone of inhibition was visible between the β-lactam and β-lactamase inhibitor-containing discs. For the E-test, ESBL strips containing ceftazidime and ceftazidime–clavulanate and strips containing cefotaxime and cefotaxime–clavulanate were used to determine the MIC ratio according to the manufacturer's instructions (AB Biodisk, Biomerieux-diagnostics, Durham, NC, USA). Cultures were incubated aerobically at 37 °C for 18–24 h. CTX-M-15 β-lactamase enzyme displays a catalytic activity toward ceftazidime.

Vali L., Dashti A.A., Jadaon M.M, & El-Shazly S. (2015). The emergence of plasmid mediated quinolone resistance qnrA2 in extended spectrum β-lactamase producing Klebsiella pneumoniae in the Middle East. DARU Journal of Pharmaceutical Sciences, 23(1), 34.

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Antimicrobial Susceptibility Profiling

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In this study, the Clinical and Laboratory Standard Institute (CLSI) guideline was followed to profile the antimicrobial susceptibility/resistance pattern of the isolates [22 ]. This profiling was performed by the modified Kirby-Bauer disc-diffusion method on Mueller–Hinton agar (MHA) plates. The only exception was Streptococcus agalactiae, which was cultured in MHA with 5% sheep blood.
Antibiotic-susceptibility test discs in cartridges for tetracycline, trimethoprim-sulfamethoxazole, rifampicin, cefoxitin, nalidixic acid, cotrimoxazole, ciprofloxacin, azithromycin, ampicillin, cefixime, gentamicin, chloramphenicol, ceftriaxone, imipenem, piperacillin-tazobactam, penicillin, vancomycin, linezolid, colistin, erythromycin, televancin and clindamycin were obtained from Oxoid (Hampshire, UK). The cartridges were stored between 4 °C and −20 °C and allowed to come to room temperature before use. After inoculation with the isolates and placement of the disks, plates were incubated at 37 °C for 24 h and the zones of inhibition were measured.

Safain K.S., Islam M.S., Amatullah J., Mahmud-Un-Nabi M.A., Bhuyan G.S., Rahman J., Sarker S.K., Islam M.T., Sultana R., Qadri F, & Mannoor K. (2023). Prevalence of silver resistance determinants and extended-spectrum β-lactamases in bacterial species causing wound infection: First report from Bangladesh. New Microbes and New Infections, 52, 101104.

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Antibiotic Resistance Profiling in Environmental and Clinical Isolates

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Antibiotic resistance profiles were obtained from 220 isolates (84 environmental isolates obtained during the dry season, 88 isolated during the wet season and 48 clinical isolates). A standardized amount was inoculated (standard 0.5 of Mc Farland) and antimicrobial susceptibility testing was determined by disk diffusion method on Mueller-Hinton (MH) agar (Difco Laboratories, Detroit, MI, USA), using interpretative criteria of the Clinical and Laboratory Standard Institute (CLSI) (Wanyne, 2015) . The following antimicrobials were used: Trimetroprim/Sulfametoxazol (SXT, 23.75 µg + 1.25 µg), Gentamicin (GEN, 10 µg), Ciprofloxacin (CIP, 5 µg), Ceftazidime (CAZ, 30 µg), Cefoxitin (FOX, 30 µg), Cefotaxime (CTX, 30 µg), Meropenem (MEM, 10 µg), Piperacillin/Tazobactam (TZP, 40 µg), Cefixime (CFM, 5 µg) (Oxoid Ltd., Hampshire, United Kingdom). Intermediate susceptibility to each antibiotic was considered to be resistance. Quality control was carried out using standard strains of Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853).
According to the definitions proposed by Magiorakos et al. (2012) , resistance to three or more antibiotic classes were defined as multidrug resistant P. aeruginosa (MDRPA).

Chávez M., Cabezas A.F., Ferauds M., Castillo J.E, & Caicedo L.D. (2020). Antimicrobial resistance patterns and genotypic diversity between clinical and water systems isolates of Pseudomonas aeruginosa in Cali, Colombia. Tropical biomedicine, 37(3).

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Antimicrobial Susceptibility Testing of E. coli

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All E coli isolates were tested for antibiotic susceptibility assay according to Kirby-Bauer disc diffusion technique (Bauer et al., 1966) as per the recommendation of Clinical and Laboratory Standards Institute (CLSI) (Weinstein et al., 2017) . Antibiotics panels have been used as a guide to testing the sensitivity of bacteria to the 13 antibiotics (Oxoid) including the following: cefotaxime (30µg), amikacin(10 µg), ceftriaxone(10 µg), cefixime(5 µg), tetracycline (30 µg), gentamicin(10 µg), ciprofloxacin(10 µg), imipenem(10 µg), amoxicillin(20 µg),, chloramphenicol(10 µg), amoxicillin/ clavulanic acid(20/10 µg), trimethoprim/ sulphamethoxazole(10/50 µg) and ampicillin(20 µg). Briefly, an overnight suspension broth culture that matched to 0.5 MacFarland Standard were uniformly inoculated by a cotton swab on Muller-Hinton agar then incubated at 37 0 C for 24 hours. Plates were then read by measurement of the zones of growth inhibition (millimetre) around each of the antibiotic disks. The zone diameters of drugs were interpreted based on Clinical and Laboratory Standards Institute criteria (noted as CLSI) (Weinstein et al., 2007) .

Hasan H.K., Yassin N.A., & Eassa S. (2020). Bacteriological and Molecular Characterization of Diarrheagenic Escherichia Coli Pathotypes From Children in Duhok City, Iraq. Science Journal of University of Zakho, 8(2), 52-57.

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