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# Cefixime
## Overview
Cefixime is a third-generation cephalosporin antibiotic with broad-spectrum activity against Gram-negative organisms (including *Haemophilus influenzae*, *Moraxella catarrhalis*, and *Neisseria* species) and limited activity against Gram-positive organisms. It is administered orally and is stable against hydrolysis by many beta-lactamases.
## 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, given as a single dose or in two divided doses (200 mg every 12 hours).
* **Uncomplicated Gonorrhea:** 800 mg as a single oral dose (Note: Consult current CDC guidelines, as combination therapy with other antibiotics is often required).
## Pediatric Dosing
* **General infections (>6 months):** 8 mg/kg/day as a single daily dose or in two divided doses (4 mg/kg every 12 hours).
* **Maximum pediatric dose:** 400 mg/day.
## Dose Adjustments
* **Renal Impairment (CrCl <20 mL/min):** Reduce dose to 200 mg once daily.
* **Hemodialysis:** No supplementary dose required; follow renal impairment guidelines.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of severe allergic reactions (e.g., anaphylaxis, Stevens-Johnson syndrome) to penicillins or other beta-lactams (cross-reactivity is rare but possible; use caution).
## Adverse Effects
* **Gastrointestinal:** Diarrhea (most common, dose-related), nausea, abdominal pain.
* **Dermatologic:** Rash, pruritus.
* **Systemic:** Potential for *Clostridioides difficile*-associated diarrhea (CDAD) or superinfection with prolonged use.
## Key Drug Interactions
* **Warfarin:** Possibility of increased anticoagulant effect. Monitor INR closely.
* **Probenecid:** May increase serum levels of cefixime by inhibiting renal excretion.
* **Live Vaccines:** Cephalosporins may theoretically decrease the immune response to certain vaccines (e.g., typhoid vaccine).
## Monitoring
* Monitor for signs of hypersensitivity (rash, anaphylaxis).
* Monitor stool frequency; investigate persistent diarrhea for *C. difficile*.
* Assess renal function (CrCl) to determine appropriate dose adjustments.
## Clinical Pearls
* **Bioavailability:** The oral suspension may produce higher peak blood levels than the tablet formulation; check product labeling for interchangeability—they are generally considered bioequivalent, but dosing instructions must be followed specifically.
* **Spectrum:** Cefixime has poor activity against *Staphylococcus aureus* and *Enterococcus* species.
* **Administration:** May be taken with or without food.
* **Dosing uncertainty:** Always consult local antibiograms and institutional guidelines, as susceptibility patterns for *N. gonorrhoeae* and common respiratory pathogens vary significantly by region.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and drug information change frequently. Always verify current prescribing information, dosing, and safety protocols through official resources (e.g., AHFS, Lexicomp, or hospital-specific policies) before prescribing or administering medication.
