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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation cephalosporin antibiotic that acts by inhibiting bacterial cell wall synthesis. It demonstrates broad-spectrum activity against many Gram-negative bacteria (including *Haemophilus influenzae*, *Moraxella catarrhalis*, and *Neisseria gonorrhoeae*) and limited activity against Gram-positive organisms.
## 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 in two divided doses of 200 mg every 12 hours.
* **Uncomplicated gonorrhea:** 800 mg orally as a single dose (note: check current CDC/local guidelines as parenteral ceftriaxone remains the preferred agent).
## Pediatric Dosing
* **General infections (Children >6 months):** 8 mg/kg/day orally, administered as a single dose or in two divided doses of 4 mg/kg every 12 hours.
* **Maximum:** 400 mg/day.
## Dose Adjustments
* **Renal Impairment:** Adjustments are required for patients with a creatinine clearance (CrCl) <60 mL/min.
* **CrCl 21–60 mL/min:** 75% of the standard dose.
* **CrCl <20 mL/min:** 50% of the standard dose.
* **Hepatic Impairment:** No specific recommendations available; use with caution.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporin antibiotics.
* History of severe allergic reactions (e.g., anaphylaxis) to penicillins or other beta-lactams due to potential cross-reactivity.
## Adverse Effects
* **Common:** Diarrhea (often dose-related), abdominal pain, nausea, dyspepsia.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (rash, urticaria, Stevens-Johnson syndrome), and seizures (rare).
## Key Drug Interactions
* **Anticoagulants:** May enhance the anticoagulant effect of warfarin (monitor INR).
* **Probenecid:** May increase serum concentrations of cefixime by inhibiting renal tubular secretion.
* **Vaccines:** May decrease the efficacy of live typhoid vaccine.
## Monitoring
* Monitor renal function in patients with baseline impairment.
* Observe for signs of secondary infection (e.g., fungal overgrowth) or severe, persistent diarrhea suggestive of *C. difficile*.
## Clinical Pearls
* **Bioavailability:** The oral suspension has higher bioavailability than the tablet form; tablets should not be substituted for suspension on a mg-per-mg basis in all clinical settings.
* **Spectrum:** Cefixime has poor activity against *Staphylococcus aureus* compared to first-generation cephalosporins.
* **Stability:** Once reconstituted, the oral suspension remains stable for 14 days at room temperature; do not refrigerate the suspension as it may thicken significantly.
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**Disclaimer:** This information is for educational purposes only. Clinical guidelines and local antimicrobial resistance patterns vary. Always verify current prescribing information, institutional protocols, and patient-specific contraindications before administering medication.
