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# Cefixime Trihydrate
## Overview
Cefixime is an oral, third-generation cephalosporin antibiotic. It exhibits broad-spectrum activity against many Gram-negative bacteria (including *Haemophilus influenzae*, *Moraxella catarrhalis*, and *Neisseria gonorrhoeae*) but has limited activity against Gram-positive organisms (e.g., *Staphylococcus aureus* is generally resistant).
## Primary Indications
* Uncomplicated gonorrhea (urethral, cervical, rectal).
* Otitis media (acute).
* Pharyngitis and tonsillitis.
* Acute exacerbation of chronic bronchitis.
* Uncomplicated urinary tract infections (UTIs).
## Adult Dosing
* **Gonorrhea:** 800 mg orally as a single dose.
* **Respiratory/UTI/Other infections:** 400 mg daily, administered as a single dose or in two divided doses (200 mg every 12 hours).
* **Maximum Dose:** 400 mg per day.
## Pediatric Dosing
* **General infections (typically ≥6 months):** 8 mg/kg/day orally, administered as a single daily dose or in two divided doses (4 mg/kg every 12 hours).
* **Maximum Dose:** 400 mg per day.
* *Note: Safety and efficacy in infants <6 months have not been established.*
## Dose Adjustments
* **Renal Impairment:** If CrCl is 21–60 mL/min, reduce dose to 75% of the standard dose. If CrCl <20 mL/min, reduce dose to 50% of the standard dose.
* **Hepatic Impairment:** No specific dosage adjustment guidelines are established; use with caution.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporin antibiotics.
* History of anaphylaxis to penicillins (use with extreme caution or avoid due to potential cross-reactivity).
## Adverse Effects
* **Common:** Diarrhea (most frequent), abdominal pain, nausea, dyspepsia, and flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome), and seizures (in patients with severe renal impairment).
## Key Drug Interactions
* **Warfarin:** May increase the anticoagulant effect (monitor INR).
* **Probenecid:** May elevate serum concentrations of cefixime by inhibiting renal excretion.
* **Oral Contraceptives:** May theoretically reduce the efficacy of estrogen-containing contraceptives (backup contraception advised).
## Monitoring
* Monitor for signs of hypersensitivity reactions during initial doses.
* Assess for persistent diarrhea to rule out *C. difficile* infection.
* In patients with renal impairment, monitor renal function (CrCl).
## Clinical Pearls
* **Bioavailability:** The suspension form exhibits higher bioavailability than the tablet form; do not substitute milligram-for-milligram between oral suspension and tablets if possible.
* **Administration:** May be taken with or without food.
* **Cross-Reactivity:** While the risk of cross-reactivity in patients with a history of penicillin allergy is low, it remains a clinical consideration in patients with severe, IgE-mediated reactions to penicillins.
* **CDC Note:** Check current CDC STI treatment guidelines as local resistance patterns for *N. gonorrhoeae* may affect the use of cefixime as monotherapy.
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**Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and local resistance patterns change frequently. Always verify the most current prescribing information via official manufacturer labeling (FDA/EMA) and consult institutional antimicrobial stewardship protocols before prescribing.
