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# Cefixime Trihydrate
## Overview
Cefixime is an oral, third-generation cephalosporin. It possesses expanded gram-negative coverage compared to first- and second-generation agents but lacks reliable activity against *Staphylococcus aureus* and has limited anaerobic coverage. It is stable against many beta-lactamases produced by gram-negative bacteria.
## Primary Indications
* Uncomplicated gonorrhea (urethral, cervical, rectal).
* Otitis media (in patients intolerant of first-line agents).
* Pharyngitis and tonsillitis.
* Acute bronchitis or acute exacerbations of chronic bronchitis.
* Uncomplicated urinary tract infections (UTIs).
## Adult Dosing
* **Gonorrhea:** 800 mg orally as a single dose (note: CDC current guidelines prefer dual therapy with ceftriaxone; check local antimicrobial stewardship protocols).
* **Other infections:** 400 mg daily, administered as a single dose or divided into 200 mg every 12 hours.
## Pediatric Dosing
* **General infections:** 8 mg/kg/day orally, administered as a single dose or divided into 4 mg/kg every 12 hours.
* **Maximum pediatric dose:** 400 mg/day.
* *Note:* Safety and efficacy in infants <6 months have not been established.
## Dose Adjustments
* **Renal Impairment:**
* CrCl 21–60 mL/min: Reduce dose by 25% (or 400 mg q24h).
* CrCl <20 mL/min: Reduce dose by 50% (or 200 mg q24h).
* **Hepatic Impairment:** No specific dosage adjustments provided by the manufacturer; use with caution.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of anaphylaxis to penicillins (cross-reactivity risk).
## Adverse Effects
* **Common:** Diarrhea (most common, dose-related), abdominal pain, nausea, dyspepsia.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity reactions (e.g., SJS/TEN), and rare hematologic abnormalities (thrombocytopenia, leukopenia).
## Key Drug Interactions
* **Warfarin/Anticoagulants:** May increase the International Normalized Ratio (INR) by potentially altering gut flora responsible for vitamin K synthesis.
* **Probenecid:** May increase serum levels of cefixime by decreasing renal tubular secretion.
## Monitoring
* Monitor for signs of hypersensitivity.
* Monitor stool frequency for persistent, severe, or bloody diarrhea suggestive of CDAD.
* Monitor renal function in patients with pre-existing impairment or elderly patients on long-term therapy.
## Clinical Pearls
* **Bioavailability:** Suspension provides higher bioavailability than tablets; verify formulation when prescribing.
* **Spectrum:** It is not a drug of choice for *S. pneumoniae*; if pneumococcal infection is suspected, use appropriate alternatives.
* **Food:** May be administered with or without food.
* **Gonorrhea:** Due to rising resistance patterns and CDC requirements for dual therapy, cefixime should only be used for gonorrhea if ceftriaxone is unavailable or contraindicated.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Prescribing practices vary by region and institutional protocol. Always consult your current institutional antibiogram, the package insert, and localized clinical guidelines (such as the CDC or IDSA) before prescribing.
