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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation cephalosporin antibiotic that acts by inhibiting bacterial cell wall synthesis. It is administered orally and possesses an extended spectrum of activity against Gram-negative organisms, including *Haemophilus influenzae*, *Moraxella catarrhalis*, and *Neisseria gonorrhoeae*, but has limited activity against *Staphylococcus aureus*.
## Primary Indications
* Uncomplicated gonorrhea (urethral, endocervical, rectal).
* Otitis media.
* Pharyngitis and tonsillitis.
* Acute bronchitis and acute exacerbations of chronic bronchitis.
* Uncomplicated urinary tract infections (UTIs).
## Adult Dosing
* **Gonorrhea:** 800 mg orally as a single dose (note: dual therapy with azithromycin or doxycycline is often standard practice per local guidelines).
* **Other indications:** 400 mg daily, administered either as a single dose or in two divided doses (200 mg every 12 hours).
## Pediatric Dosing
* **Common Infections (Otitis media, pharyngitis, UTI):** 8 mg/kg/day orally, administered as a single daily dose or in two divided doses of 4 mg/kg every 12 hours.
* **Maximum dose:** 400 mg per day.
* *Note: Use oral suspension for children unable to swallow tablets; duration typically 7–14 days depending on indication.*
## Dose Adjustments
* **Renal Impairment:** If CrCl 21–60 mL/min, reduce dose by 25%. If CrCl <20 mL/min, reduce dose by 50%.
* **Hepatic Impairment:** No specific dosage adjustment guidelines provided; use with caution.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins (cross-reactivity with penicillins occurs in <10% of patients; exercise extreme caution in patients with history of severe penicillin anaphylaxis).
## Adverse Effects
* **Common:** Diarrhea (often dose-related), abdominal pain, nausea, dyspepsia, and flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome), and seizures (rare).
## Key Drug Interactions
* **Anticoagulants:** May enhance the anticoagulant effect of warfarin (monitor PT/INR).
* **Salicylates:** Potential for increased systemic exposure.
* **Probenecid:** May elevate cefixime serum concentrations by inhibiting renal excretion.
## Monitoring
* Monitor for signs of hypersensitivity reactions during the first dose.
* Observe for diarrhea; discontinue if CDAD is suspected.
* Renal function should be monitored in patients with pre-existing renal impairment or those on prolonged therapy.
## Clinical Pearls
* Cefixime is generally not the drug of choice for *S. pneumoniae* due to variable susceptibility.
* Clinical efficacy against *N. gonorrhoeae* has been decreasing; refer to current CDC or local infectious disease guidelines for updated treatment recommendations.
* Oral suspension should be refrigerated if noted by the manufacturer, but is stable at room temperature for specified periods; check product label.
* Take with or without food; taking with food may help minimize gastrointestinal distress.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines vary by region and institution. Physicians and pharmacists must verify current prescribing information, institutional protocols, and patient-specific factors before administering any medication.
