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# Cefixime
## Overview
Cefixime is an oral, third-generation cephalosporin. It possesses broad-spectrum activity against many Gram-negative bacteria (including *Enterobacteriaceae* and *Neisseria*) but generally lacks reliable activity against *Staphylococcus* species and has limited activity against *Streptococcus pneumoniae*. It is stable against many beta-lactamases.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Uncomplicated gonorrhea (cervical, urethral, and rectal)
* Acute bronchitis or acute exacerbations of chronic bronchitis
## Adult Dosing
* **General Infections:** 400 mg daily, administered as a single dose or divided into 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** 800 mg as a single oral dose (Note: Review local guidelines, as ceftriaxone injection is often preferred).
## Pediatric Dosing
* **Patients >6 months and <50 kg:** 8 mg/kg/day, administered as a single daily dose or divided into 4 mg/kg every 12 hours.
* **Maximum Dose:** 400 mg per day.
## Dose Adjustments
* **Renal Impairment:** If CrCl is 21–60 mL/min, administer 75% of the standard dose. If CrCl <20 mL/min, administer 50% of the standard dose.
* **Hepatic Impairment:** No specific dosage adjustments established.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* Patients with a history of severe immediate hypersensitivity reactions (e.g., anaphylaxis) to penicillins or other beta-lactams.
## Adverse Effects
* **Common:** Diarrhea (often dose-related), abdominal pain, nausea, dyspepsia, and flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (skin rashes, urticaria), and rarely, Stevens-Johnson syndrome or toxic epidermal necrolysis.
## Key Drug Interactions
* **Warfarin/Anticoagulants:** May enhance the anticoagulant effect by depleting vitamin K-producing gut flora. Monitor INR.
* **Probenecid:** May increase serum concentrations of cefixime by inhibiting renal excretion.
## Monitoring
* Monitor for signs and symptoms of *C. difficile* diarrhea (profuse, watery, or bloody stools).
* Assess for resolution of infection symptoms.
* Monitor renal function in patients with pre-existing impairment.
## Clinical Pearls
* Cefixime suspension is preferred over tablets for many pediatric patients; note that the bioavailability of the suspension is slightly higher than the tablet.
* Cefixime is generally ineffective against methicillin-resistant *Staphylococcus aureus* (MRSA) and *Pseudomonas aeruginosa*.
* Diarrhea is the most frequently reported side effect; advise patients to contact a provider if diarrhea becomes severe or persists.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice protocols vary by region and institution. Always verify dosages, contraindications, and drug interactions against the most current institutional guidelines, local antibiograms, and official FDA/EMA prescribing information before administration.
