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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation, semi-synthetic cephalosporin antibiotic. It is administered orally and exhibits broad-spectrum activity against many Gram-positive and Gram-negative bacteria by inhibiting bacterial cell wall synthesis. It is highly stable against many beta-lactamases.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Acute bronchitis and acute exacerbations of chronic bronchitis
* Uncomplicated gonorrhea (cervical, urethral, and rectal)
## Adult Dosing
* **General infections:** 400 mg daily, administered either as a single dose or in two divided doses (200 mg every 12 hours).
* **Uncomplicated gonorrhea:** 800 mg as a single oral dose.
* *Note:* Oral bioavailability is approximately 40-50%.
## Pediatric Dosing
* **General infections (Children > 6 months):** 8 mg/kg/day administered as a single dose or in two divided doses (4 mg/kg every 12 hours).
* **Otitis media:** 8 mg/kg/day once daily or 4 mg/kg BID.
* *Maximum dose:* Do not exceed adult maximum daily dose (400 mg).
## Dose Adjustments
* **Renal Impairment:**
* CrCl 21–60 mL/min: Reduce dose by 25% (e.g., 300 mg daily).
* CrCl < 20 mL/min: Reduce dose by 50% (e.g., 200 mg daily).
* Hemodialysis/CAPD: No supplemental dose required.
* **Hepatic Impairment:** No specific adjustment required.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of severe allergic reactions (e.g., anaphylaxis) to penicillins or other beta-lactams is a relative contraindication due to potential cross-reactivity.
## Adverse Effects
* **Common:** Diarrhea (frequent), abdominal pain, nausea, dyspepsia, and flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), and seizures (at high doses in renal failure).
## Key Drug Interactions
* **Anticoagulants:** Potential for increased INR/prothrombin time; monitor patients closely if co-administered with warfarin.
* **Probenecid:** May increase serum concentrations and half-life of cefixime by inhibiting renal excretion.
* **Carbamazepine:** Cefixime may rarely alter the metabolism or serum levels of carbamazepine; monitor closely.
## Monitoring
* **Efficacy:** Resolution of symptoms and clinical improvement.
* **Toxicity:** Monitor for persistent diarrhea (signs of CDAD) and signs of hypersensitivity (rash, urticaria).
* **Renal Function:** Periodically assess renal function in patients requiring long-term therapy or with pre-existing impairment.
## Clinical Pearls
* **Administration:** Cefixime may be taken with or without food.
* **Diarrhea:** The drug-induced diarrhea is frequently related to the dosage; divided dosing may improve gastrointestinal tolerance.
* **Gonorrhea:** Due to emerging resistance, local antimicrobial susceptibility patterns must be reviewed. Current CDC guidelines often recommend combination therapy for gonorrhea; verify current institutional or national treatment guidelines.
* **Absorption:** The oral suspension has higher bioavailability than the tablet formulation.
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**Educational Disclaimer:** This information is intended for educational purposes for healthcare professionals and does not constitute medical advice. Always verify current prescribing information, institutional protocols, and patient-specific factors before administration. Prescription dosing should be confirmed with the most recent clinical guidelines or the official FDA-approved package insert.
