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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation, semi-synthetic cephalosporin antibiotic. It exhibits broad-spectrum activity against many Gram-negative bacteria (including *Neisseria gonorrhoeae*, *H. influenzae*, and *Moraxella catarrhalis*) and limited activity against Gram-positive organisms. It is administered orally and demonstrates high stability in the presence of beta-lactamases.
## Primary Indications
* Uncomplicated gonorrhea (urethral, endocervical, rectal).
* Otitis media.
* Pharyngitis and tonsillitis.
* Acute bronchitis and acute exacerbations of chronic bronchitis.
* Uncomplicated urinary tract infections (UTIs).
## Adult Dosing
* **Gonorrhea:** 800 mg orally as a single dose.
* **Other infections:** 400 mg daily, administered either as a single dose or divided into 200 mg every 12 hours.
## Pediatric Dosing
* **Children (>6 months):** 8 mg/kg/day orally, administered either as a single dose or divided into 4 mg/kg every 12 hours.
* **Maximum:** Do not exceed the adult dose of 400 mg per day.
## Dose Adjustments
* **Renal Impairment:**
* CrCl 21–60 mL/min: Reduce dose to 75% of the standard dose (300 mg/day).
* CrCl <20 mL/min: Reduce dose to 50% of the standard dose (200 mg/day).
* **Hepatic Impairment:** No official dosage adjustment required.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of severe, immediate hypersensitivity reactions (e.g., anaphylaxis) to penicillins or other beta-lactams (due to potential cross-reactivity).
## Adverse Effects
* **Common:** Diarrhea (most frequent), abdominal pain, nausea, dyspepsia, and flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (rash, urticaria, Stevens-Johnson syndrome), and elevated liver enzymes.
## Key Drug Interactions
* **Warfarin:** Cefixime may enhance the anticoagulant effect by altering gut microflora (vitamin K reduction). Monitor INR/PT closely.
* **Probenecid:** May elevate cefixime serum concentrations by inhibiting renal excretion.
* **BCG Vaccine/Typhoid Vaccine:** Antibiotics may reduce the therapeutic efficacy of these live vaccines.
## Monitoring
* Monitor for signs of hypersensitivity, especially upon initiation.
* Assess for persistent diarrhea to rule out *C. difficile* infection.
* In prolonged therapy, assess renal and hepatic function, and monitor for hematologic changes (e.g., leukopenia, thrombocytopenia).
## Clinical Pearls
* **Bioavailability:** The suspension has higher bioavailability than the tablet form; refer to local pharmacy protocols regarding interchangeability.
* **Spectrum:** Poor activity against *Staphylococcus aureus* (methicillin-susceptible or resistant) and *Enterococcus* species.
* **Food:** Can be taken with or without food.
* **Gonorrhea:** Due to increasing resistance in some regions, follow current CDC/local public health guidelines regarding dual therapy (e.g., typically combined with a dose of azithromycin or doxycycline if chlamydia cannot be ruled out).
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**Disclaimer:** This information is for educational purposes only. Clinical guidelines and dosing recommendations may change based on regional resistance patterns and updated clinical research. Verify all dosages and contraindications against current local institutional protocols and official prescribing information (package insert) before initiation.
