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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation, oral cephalosporin antibiotic. It exhibits broad-spectrum activity against Gram-negative bacteria (e.g., *Haemophilus influenzae*, *Moraxella catarrhalis*, *Neisseria gonorrhoeae*) and limited activity against Gram-positive organisms (e.g., *Streptococcus pneumoniae*). It is stable to hydrolysis by many beta-lactamases.
## 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 (UTIs).
## Adult Dosing
* **Gonorrhea:** 800 mg orally as a single dose.
* **Respiratory/UTI Infections:** 400 mg daily, administered either as a single dose or in two divided doses of 200 mg every 12 hours.
## Pediatric Dosing
* **General infections (>6 months):** 8 mg/kg/day orally, administered as a single daily dose or in two divided doses of 4 mg/kg every 12 hours.
* **Maximum dose:** 400 mg/day.
## Dose Adjustments
* **Renal Impairment:**
* CrCl 21–60 mL/min: Reduce dose to 75% of the standard dose (e.g., 300 mg daily).
* CrCl <20 mL/min: Reduce dose to 50% of the standard dose (e.g., 200 mg daily).
* **Hepatic Impairment:** No specific dosage adjustment required.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins (cross-reactivity with penicillins occurs in ~5–10% of patients with history of anaphylaxis; use with extreme caution or avoid).
## Adverse Effects
* **Gastrointestinal:** Diarrhea (frequent, commonly associated with oral administration), abdominal pain, nausea, *Clostridioides difficile*-associated diarrhea.
* **Dermatologic:** Rash, pruritus, urticaria.
* **Hematologic:** Transient neutropenia, agranulocytosis.
* **Neurologic:** Dizziness, headache.
## Key Drug Interactions
* **Anticoagulants (e.g., Warfarin):** May increase INR. Monitor prothrombin time/INR.
* **Probenecid:** May increase cefixime serum concentrations by inhibiting renal excretion.
* **Vaccines:** May decrease the efficacy of live typhoid vaccine.
## Monitoring
* Monitor for signs of hypersensitivity/anaphylaxis.
* If treatment is prolonged, monitor renal and hepatic function.
* Monitor for liquid stool/diarrhea suggesting *C. difficile* infection.
## Clinical Pearls
* **Bioavailability:** Suspension has higher bioavailability than tablets; dosing may differ slightly between formulations. Ensure the correct formulation is selected.
* **Gonorrhea:** Cefixime is generally not the first-line monotherapy for gonorrhea due to increasing MIC values; guidelines often recommend dual therapy with ceftriaxone injection if available.
* **Spectrum:** It has poor activity against *Staphylococcus aureus*. Do not use for suspected skin and soft tissue infections unless susceptibility is confirmed.
* **Adherence:** Can be taken with or without food.
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**Disclaimer:** This information is for educational purposes and reflects general clinical guidelines. Dosing may vary based on local institutional protocols, institutional antibiograms, and specific patient factors. Always verify current prescribing information in a trusted clinical resource (e.g., UpToDate, Lexicomp, or the manufacturer’s package insert) before prescribing or administering medication.
