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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 bacteria and selected Gram-positive organisms. It is available as oral tablets and an oral suspension.
## Primary Indications
* Uncomplicated gonorrhea (urethral, endocervical, rectal).
* Otitis media (pediatric).
* Pharyngitis and tonsillitis.
* Acute bronchitis and acute exacerbations of chronic bronchitis.
* Uncomplicated urinary tract infections.
## Adult Dosing
* **Gonorrhea (Uncomplicated):** 800 mg orally as a single dose.
* **Other Infections:** 400 mg daily, administered as a single dose or in two divided doses (200 mg every 12 hours).
## Pediatric Dosing
* **General Infections (>6 months):** 8 mg/kg/day orally as a single dose or in two divided doses (4 mg/kg every 12 hours).
* **Maximum:** 400 mg/day.
* **Note:** Dosing should be based on clinical judgment and local institutional protocols.
## Dose Adjustments
* **Renal Impairment:** If CrCl is 21–60 mL/min, administer 75% of the standard dose. If CrCl is <20 mL/min, administer 50% of the standard dose. Hemodialysis does not effectively remove cefixime.
* **Hepatic Impairment:** No specific dosage adjustment required.
## Contraindications
* Known hypersensitivity (anaphylaxis or severe cutaneous adverse reactions) to cefixime or any cephalosporin antibiotic.
## Adverse Effects
* **Common:** Diarrhea (most frequent), abdominal pain, nausea, dyspepsia, flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis).
## Key Drug Interactions
* **Warfarin/Anticoagulants:** May enhance the anticoagulant effect by depleting vitamin K-producing gut flora. Monitor INR.
* **Probenecid:** May increase serum levels of cefixime by inhibiting renal excretion; monitor for increased toxicity.
## Monitoring
* Monitor for signs of hypersensitivity, especially at the start of therapy.
* Monitor stool frequency and consistency in patients presenting with persistent diarrhea to evaluate for *C. difficile* infection.
* Renal function should be monitored if long-term treatment is required.
## Clinical Pearls
* **Bioavailability:** The oral suspension has higher bioavailability than the tablet formulation; avoid switching between formulations without adjusting the dose if necessary.
* **Gram-positive coverage:** Cefixime has limited activity against *Staphylococcus aureus* or *Enterococcus* species.
* **Administration:** May be taken with or without food.
* **Cross-reactivity:** Use with caution in patients with a history of penicillin allergy; if the reaction was IgE-mediated (e.g., anaphylaxis), cephalosporins should be avoided.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical guidelines and local resistance patterns change frequently. Always consult the most current prescribing information, institutional formulary, and clinical pharmacology databases before prescribing or administering medication.
