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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis. It demonstrates broad-spectrum activity against many Gram-negative organisms (including *Haemophilus influenzae*, *Moraxella catarrhalis*, and *Neisseria* species) and some Gram-positive bacteria, though it lacks reliable coverage against *Staphylococcus aureus*.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Uncomplicated gonorrhea (cervical, urethral, and rectal)
* Acute exacerbations of chronic bronchitis
## Adult Dosing
* **General infections:** 400 mg daily, administered as a single dose or divided into 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** 800 mg orally as a single dose.
* *Note: Always consult local antibiogram and current CDC/IDSA guidelines, as resistance patterns vary.*
## Pediatric Dosing
* **Children (>6 months):** 8 mg/kg/day orally, administered as a single daily dose or divided into two doses (4 mg/kg every 12 hours).
* **Maximum dose:** 400 mg per day.
* *Note: Safety and efficacy in infants <6 months have not been established.*
## Dose Adjustments
* **Renal Impairment:** Adjustments required for CrCl <60 mL/min.
* CrCl 21–60 mL/min: Reduce dose to 75% of the standard dose.
* CrCl ≤20 mL/min: Reduce dose to 50% of the standard dose.
* **Hepatic Impairment:** No specific dosage adjustments established.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of severe allergic reactions (e.g., anaphylaxis) to penicillins or other beta-lactams (use with extreme caution due to cross-reactivity).
## Adverse Effects
* **Common:** Diarrhea (frequently dose-related), nausea, abdominal pain, and dyspepsia.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome), and seizures (rare).
## Key Drug Interactions
* **Warfarin/Anticoagulants:** May enhance the effects of anticoagulants; monitor INR closely.
* **Probenecid:** Can inhibit renal excretion of cefixime, leading to increased serum levels.
* **Live Vaccines:** Cefixime may decrease the efficacy of the BCG vaccine or typhoid vaccine; avoid concomitant use.
## Monitoring
* **Renal Function:** Monitor periodically in patients with chronic impairment.
* **Gastrointestinal:** Monitor for persistent or bloody diarrhea, which may indicate *C. difficile* infection.
* **Allergic symptoms:** Monitor for rash, pruritus, or dyspnea.
## Clinical Pearls
* **Administration:** May be taken with or without food.
* **Absorption:** The tablet and suspension formulations are not strictly bioequivalent; if switching formulations, clinical judgment should be used.
* **Spectrum:** Does not cover *Pseudomonas* species.
* **Adherence:** Complete the full course of therapy even if symptoms resolve to prevent resistance.
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**Educational Disclaimer:** This information is for educational purposes only. Always consult the most recent product labeling (package insert), your institution's anti-infective formulary, and current clinical guidelines (e.g., CDC/IDSA) before prescribing or administering medication. Confirm patient-specific factors such as allergies, weight, and renal/hepatic function prior to dosing.
