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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation, oral cephalosporin antibiotic. It exhibits broad-spectrum activity against many Gram-negative bacteria but has limited activity against Gram-positive organisms (e.g., poor *Staphylococcus aureus* coverage).
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Uncomplicated gonorrhea (cervical, urethral, and rectal)
* Acute bronchitis/exacerbations of chronic bronchitis
## Adult Dosing
* **General infections:** 400 mg daily, given as a single dose or divided into two 200 mg doses every 12 hours.
* **Uncomplicated Gonorrhea:** 800 mg orally as a single dose (note: check current CDC guidelines, as monotherapy is often discouraged due to emerging resistance; dual therapy with ceftriaxone is preferred).
## Pediatric Dosing
* **Children (>6 months):** 8 mg/kg/day, administered as a single daily dose or in two divided doses every 12 hours.
* Maximum dose: 400 mg/day.
## Dose Adjustments
* **Renal Impairment:** If CrCl <20 mL/min, reduce dosage to 200 mg once daily.
* **Hemodialysis/Peritoneal Dialysis:** No supplemental dose required after dialysis.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of severe hypersensitivity reactions (anaphylaxis) to penicillins or other beta-lactam antibiotics (cross-reactivity risk).
## Adverse Effects
* **Gastrointestinal:** Diarrhea (very common), nausea, abdominal pain, dyspepsia.
* **Dermatologic:** Rash, pruritus, urticaria.
* **Other:** Superinfection (e.g., *C. difficile*-associated diarrhea/colitis), transient elevation of AST/ALT.
## Key Drug Interactions
* **Warfarin:** May enhance the anticoagulant effect of vitamin K antagonists due to alteration of gut flora; monitor INR closely.
* **Probenecid:** May increase serum levels of cefixime by inhibiting renal excretion.
## Monitoring
* Monitor for signs of *C. difficile*-associated diarrhea (watery/bloody stools, fever).
* In prolonged therapy: Monitor renal and hepatic function.
* Ensure resolution of clinical symptoms; repeat cultures only if infection persists.
## Clinical Pearls
* **Bioavailability:** The oral suspension is more bioavailable than the tablet formulation; they are not strictly bioequivalent milligram-for-milligram in all contexts.
* **Food effect:** Can be administered with or without food.
* **Spectrum:** Does not cover *Pseudomonas aeruginosa*.
* **Resistance:** Increasing resistance in *Neisseria gonorrhoeae* has limited its use as first-line monotherapy.
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*Disclaimer: This information is for educational purposes only. Clinical guidelines change frequently; always verify doses, contraindications, and drug interactions with the most current institutional protocols and the official FDA package insert before prescribing.*
