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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation cephalosporin antibiotic. It exhibits broad-spectrum activity against many Gram-negative bacteria (including *Haemophilus influenzae*, *Moraxella catarrhalis*, and *Neisseria gonorrhoeae*) and some Gram-positive activity, though it is generally less active against *Staphylococcus aureus* than earlier generations.
## Primary Indications
* Uncomplicated gonorrhea (cervical, urethral, rectal)
* Acute otitis media (AOM)
* Pharyngitis and tonsillitis
* Acute exacerbations of chronic bronchitis
* Uncomplicated urinary tract infections (UTI)
## Adult Dosing
* **Uncomplicated Gonorrhea:** 800 mg orally as a single dose (note: CDC guidelines currently recommend 500 mg IM Ceftriaxone; Cefixime is an alternative if Ceftriaxone is unavailable).
* **Respiratory/UTI:** 400 mg daily or 200 mg every 12 hours.
* *Maximum dose:* 400 mg/day for standard infections.
## Pediatric Dosing
* **General infections:** 8 mg/kg/day orally, administered as a single daily dose or in two divided doses (4 mg/kg every 12 hours).
* **AOM:** 8 mg/kg/day once daily or 4 mg/kg twice daily.
* *Note:* Pediatric dosing should not exceed the adult maximum of 400 mg/day.
## Dose Adjustments
* **Renal Impairment:**
* CrCl 21–60 mL/min: Reduce dose to 75% of the standard dose.
* CrCl <20 mL/min (or hemodialysis): Reduce dose to 50% of the standard dose.
* **Hepatic Impairment:** No standard dosage adjustments provided; use with caution.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporin antibiotics.
* History of severe allergic reactions (anaphylaxis/urticaria) to penicillins (due to potential cross-reactivity).
## Adverse Effects
* **Common:** Diarrhea (frequently dose-related), abdominal pain, nausea, dyspepsia.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome), hematologic abnormalities (thrombocytopenia, leukopenia).
## Key Drug Interactions
* **Anticoagulants (e.g., Warfarin):** May increase INR/risk of bleeding; monitor closely.
* **Probenecid:** Inhibits renal excretion of cefixime, increasing serum concentrations.
* **Live Vaccines (e.g., BCG, Typhoid):** Antibiotics may decrease the therapeutic effect of the vaccine.
## Monitoring
* Monitor for signs of hypersensitivity, especially with the first dose.
* Assess for persistent diarrhea to rule out *C. difficile* infection.
* In prolonged therapy: Monitor renal and hepatic function, and complete blood count (CBC).
## Clinical Pearls
* **Bioavailability:** Suspension has higher bioavailability than tablets; they are not strictly interchangeable on a mg-per-mg basis in all settings.
* **Spectrum:** Not effective against *Pseudomonas aeruginosa* or methicillin-resistant *Staphylococcus aureus* (MRSA).
* **Safety:** GI side effects (diarrhea) are the most common reason for discontinuation. Advise patients to take with food to minimize GI upset.
* **Compliance:** Once-daily dosing is often preferred to enhance adherence.
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**Disclaimer:** This information is for educational purposes only. Always consult current institutional protocols, the package insert, and evidence-based clinical databases (e.g., Lexicomp, UpToDate, or Micromedex) before prescribing or administering medication. Individual patient factors must be considered.
