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# Cefixime
## Overview
Cefixime is an oral, third-generation cephalosporin antibiotic. It exhibits broad-spectrum activity against Gram-negative bacteria (e.g., *Haemophilus influenzae*, *Moraxella catarrhalis*, *Neisseria gonorrhoeae*) and limited activity against Gram-positive organisms (e.g., *Streptococcus pneumoniae*). It is stable to hydrolysis by many beta-lactamases.
## Primary Indications
* Uncomplicated gonorrhea (urethral, cervical, rectal).
* Otitis media (in patients intolerant of first-line agents).
* Pharyngitis and tonsillitis.
* Acute exacerbations of chronic bronchitis.
* Uncomplicated urinary tract infections (UTIs).
## Adult Dosing
* **Gonorrhea:** 800 mg orally as a single dose.
* **Respiratory tract/UTI:** 400 mg daily, administered as a single dose or in two divided doses (200 mg BID).
## Pediatric Dosing
* **Patients >6 months and <50 kg:** 8 mg/kg/day orally, administered as a single dose or in two divided doses (4 mg/kg BID).
* **Safety note:** Safety and efficacy in infants under 6 months have not been established.
## Dose Adjustments
* **Renal Impairment:** For CrCl 21–60 mL/min, administer 75% of the standard dose. For CrCl <20 mL/min, administer 50% of the standard dose.
* **Hemodialysis/CAPD:** Supplemental dosing is generally not required; patients can receive 50% of the standard dose.
## 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.
## Adverse Effects
* **Common:** Diarrhea (frequent, dose-related), abdominal pain, nausea, dyspepsia, and headache.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (rash, drug fever), and rare cases of hemolytic anemia or elevated liver enzymes.
## Key Drug Interactions
* **Warfarin:** May increase INR/prothrombin time; monitor closely during initiation or discontinuation.
* **Probenecid:** May increase serum concentrations of cefixime by reducing renal tubular secretion.
## Monitoring
* Monitor for signs of hypersensitivity.
* Assess for persistent diarrhea (to rule out *C. difficile*).
* Monitor renal function in patients with pre-existing impairment.
## Clinical Pearls
* **Bioavailability:** Suspension has higher bioavailability than tablets; verify formulations when switching.
* **Administration:** May be taken with or without food.
* **Spectrum:** Cefixime has poor activity against *Staphylococcus aureus* and *Enterococcus* species.
* **Local Resistance:** Always consult local antibiograms; resistance patterns for *N. gonorrhoeae* and respiratory pathogens vary geographically.
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*Disclaimer: This information is for educational purposes only. Dosing protocols can vary by institution and patient-specific factors. Always verify current prescribing information, package inserts, and hospital guidelines before administering medication.*
