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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation, oral cephalosporin antibiotic. It exhibits broad-spectrum activity against many Gram-negative bacteria (including *Haemophilus influenzae* and *Moraxella catarrhalis*) and limited activity against Gram-positive organisms. It is not active against *Staphylococcus aureus* or *Pseudomonas* species.
## 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 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** 800 mg as a single oral dose (Note: While historically 400 mg, current CDC guidelines for disseminated or persistent infections may require combination therapy; consult local regional antibiograms).
* **Max dose:** 400 mg/day for most indications (except gonorrhea).
## Pediatric Dosing
* **Children > 6 months:** 8 mg/kg/day, administered as a single daily dose or divided into two doses (4 mg/kg every 12 hours).
* **Max pediatric dose:** 400 mg/day.
## Dose Adjustments
* **Renal Impairment (CrCl 21–60 mL/min):** Reduce dose to 75% of the standard dose.
* **Renal Impairment (CrCl < 20 mL/min):** Reduce dose to 50% of the standard dose.
* **Hemodialysis/PD:** No supplemental dose is necessary.
## 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; use with extreme caution or avoid.
## Adverse Effects
* **Common:** Diarrhea (frequently dose-related), abdominal pain, nausea, dyspepsia, and flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (rash, urticaria, serum sickness), and rare cases of Stevens-Johnson syndrome or toxic epidermal necrolysis.
## Key Drug Interactions
* **Warfarin:** May enhance the anticoagulant effect by altering gut flora (vitamin K synthesis). Monitor INR.
* **Probenecid:** May elevate cefixime serum concentrations by inhibiting renal tubular secretion.
## Monitoring
* Monitor for signs of anaphylaxis during the first dose.
* Monitor for persistent diarrhea (suspect CDAD).
* In patients with renal impairment, monitor baseline and periodic renal function.
## Clinical Pearls
* **Suspension Stability:** Reconstituted oral suspension must be discarded after 14 days; do not refrigerate.
* **Administration:** May be taken with or without food.
* **Bioavailability:** The oral suspension has higher bioavailability than the tablet form; do not substitute milligram-for-milligram without consideration.
* **Cross-reactivity:** Patients with a history of severe penicillin allergy should generally avoid cephalosporins due to the risk of cross-reactivity.
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*Disclaimer: Clinical protocols vary by institution and region. This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional guidelines, and local susceptibility patterns before prescribing or administering medication.*
