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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation, broad-spectrum oral cephalosporin. It possesses enhanced activity against Gram-negative organisms (e.g., *Haemophilus influenzae*, *Moraxella catarrhalis*, *Neisseria gonorrhoeae*) compared to earlier generations, but has limited activity against *Staphylococcus aureus*.
## Primary Indications
* Uncomplicated urinary tract infections.
* Otitis media.
* Pharyngitis and tonsillitis.
* Acute exacerbations of chronic bronchitis.
* Uncomplicated gonorrhea (cervical, urethral, and rectal).
## Adult Dosing
* **Respiratory/UTI:** 400 mg daily as a single dose or divided into 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** 800 mg as a single oral dose (note: check current CDC/local guidelines for dual-therapy requirements, typically involving ceftriaxone or concurrent chlamydia coverage).
## Pediatric Dosing
* **General Infections (≥6 months):** 8 mg/kg/day administered as a single daily dose or in two divided doses (4 mg/kg twice daily).
* **Max Daily Dose:** 400 mg.
## Dose Adjustments
* **Renal Impairment:** For CrCl 21–60 mL/min, administer 75% of the standard dose. For CrCl <20 mL/min, administer 50% of the standard dose.
* **Hepatic Impairment:** No specific dosage adjustments established.
## Contraindications
* Hypersensitivity to cefixime or other cephalosporins.
* Cross-reactivity may occur in patients with severe penicillin allergies (e.g., anaphylaxis).
## Adverse Effects
* **Common:** Diarrhea, abdominal pain, nausea, dyspepsia, flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity/anaphylaxis, Stevens-Johnson syndrome/TEN (rare).
## Key Drug Interactions
* **Warfarin/Anticoagulants:** May enhance the anticoagulant effect by altering intestinal flora (monitor INR).
* **Probenecid:** May increase serum levels of cefixime by inhibiting renal excretion.
* **Carbamazepine:** Cefixime may increase carbamazepine levels.
## Monitoring
* Monitor for signs of hypersensitivity reactions.
* If treatment is prolonged, evaluate complete blood count and renal function periodically.
* Monitor for persistent diarrhea or signs of colitis.
## Clinical Pearls
* **Bioavailability:** The suspension form usually has higher bioavailability than the tablet form; they are not strictly bioequivalent milligram-for-milligram in all clinical settings.
* **Spectrum:** While it covers many Gram-negatives, it is generally ineffective against *Pseudomonas aeruginosa* and methicillin-resistant *Staphylococcus aureus* (MRSA).
* **Administration:** May be taken with or without food.
* **Gonorrhea:** Due to rising resistance patterns, always consult local public health guidelines (e.g., CDC STD Treatment Guidelines) as cefixime monotherapy may no longer be the preferred first-line agent.
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**Educational Disclaimer:** This information is for educational purposes only. Always consult current institutional protocols, official package inserts, and local clinical guidelines before prescribing or administering medication. Clinical practice is subject to change based on new evidence.
