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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis. It is stable against hydrolysis by many beta-lactamases and possesses a broad spectrum of activity against Gram-negative organisms (e.g., *Haemophilus influenzae*, *Moraxella catarrhalis*, and *Neisseria gonorrhoeae*). It has limited activity against Gram-positive organisms (e.g., *Staphylococcus aureus* is generally resistant).
## Primary Indications
* Uncomplicated gonorrhea (urethral, endocervical, rectal).
* Otitis media (often second-line).
* Pharyngitis and tonsillitis.
* Acute bronchitis and acute exacerbations of chronic bronchitis.
* Uncomplicated urinary tract infections.
## Adult Dosing
* **Uncomplicated Gonorrhea:** 800 mg orally as a single dose.
* **Other Infections:** 400 mg orally daily, administered either as a single dose or divided into 200 mg every 12 hours.
## Pediatric Dosing
* **General Dosage:** 8 mg/kg/day orally, administered as a single dose or divided every 12 hours.
* **Maximum Dosage:** 400 mg daily.
* *Note:* Pediatric dosing should be weight-based; always confirm calculation against current institutional guidelines or standard pediatric references (e.g., Harriet Lane).
## Dose Adjustments
* **Renal Impairment:**
* eGFR 21–60 mL/min: Reduce dose by 25% (or 75% of standard dose).
* eGFR ≤20 mL/min: Reduce dose by 50% (or 50% of standard dose).
* **Hepatic Impairment:** No specific guidelines available; use with caution.
## Contraindications
* Hypersensitivity to cefixime or other cephalosporins (consider cross-reactivity in patients with severe penicillin anaphylaxis).
## Adverse Effects
* **Common:** Diarrhea (frequently dose-related), abdominal pain, nausea, dyspepsia.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (anaphylaxis, serum sickness), Stevens-Johnson syndrome, and toxic epidermal necrolysis.
## Key Drug Interactions
* **Warfarin:** Cefixime may enhance the anticoagulant effect by altering gut microflora (vitamin K production); monitor INR.
* **Probenecid:** May increase serum concentrations of cefixime via inhibition of renal tubular secretion.
## Monitoring
* Monitor for signs of hypersensitivity.
* Assess for resolution of infection symptoms.
* Monitor for severe or persistent diarrhea; evaluate for *C. difficile* if symptoms occur.
* Monitor renal function in patients with pre-existing impairment.
## Clinical Pearls
* **Bioavailability:** The suspension form and tablet form are not strictly bioequivalent in all conditions; check the specific product formulation.
* **GI Utility:** The high rate of diarrhea can be mitigated by splitting the 400 mg daily dose into two 200 mg doses.
* **Coverage Gap:** Cefixime provides poor coverage against *Staphylococcus aureus* and has variable activity against *Streptococcus pneumoniae*. It is not indicated for empiric therapy of infections where these pathogens are suspected.
* **Gonorrhea:** Due to emerging resistance, local susceptibility patterns and current CDC treatment guidelines should always be consulted for gonorrhea.
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**Disclaimer:** This information is for educational purposes only. Clinical practice is subject to constant change based on new evidence. Always verify dosing, contraindications, and drug interactions using current, institutional-approved resources or the official FDA-approved labeling (Package Insert) before prescribing or administering medication.
