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# Cefixime trihydrate
## Overview
Cefixime is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria. It is administered orally.
## Primary Indications
* Acute otitis media
* Acute exacerbations of chronic bronchitis
* Uncomplicated urinary tract infections
* Pharyngitis/tonsillitis
* Uncomplicated gonorrhea
## Adult Dosing
* **General Dosing:** 400 mg orally once daily or 200 mg orally every 12 hours.
* **Uncomplicated Gonorrhea:** 400 mg orally as a single dose.
* **Maximum Dose:** 400 mg once daily or 800 mg total daily for other indications unless otherwise specified by local protocol.
## Pediatric Dosing
* **General Dosing:** 8 mg/kg orally once daily or 4 mg/kg orally every 12 hours.
* **Maximum Dose:** Typically 400 mg once daily. Dosing may vary based on indication and local protocol.
* **Age:** Generally for children aged 6 months and older. Safety and efficacy in younger children are not well established.
## Dose Adjustments
* **Renal Impairment:**
* **CrCl > 60 mL/min:** No dose adjustment needed.
* **CrCl 31-60 mL/min:** 200 mg every 12 hours or 400 mg once daily.
* **CrCl < 30 mL/min:** 200 mg once daily.
* **Hemodialysis:** 200 mg once daily, regardless of dialysis schedule.
## Contraindications
* Known hypersensitivity to cefixime, other cephalosporins, penicillins, or other components of the formulation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache.
* **Serious:** Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridioides difficile-associated diarrhea, cholestatic jaundice, hepatic dysfunction, renal dysfunction, seizures (rare).
## Key Drug Interactions
* **Warfarin:** Monitor INR closely as cefixime may increase the effect of warfarin.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels and symptoms.
* **Certain Vaccines:** Live bacterial vaccines (e.g., cholera vaccine) may be less effective. Postpone vaccination until after finishing cefixime therapy.
## Monitoring
* Assess for signs and symptoms of allergic reactions.
* Monitor for resolution of infection.
* Monitor bowel function for C. difficile-associated diarrhea.
* Monitor renal function in patients with pre-existing renal impairment or when co-administered with nephrotoxic drugs.
* Monitor INR in patients on warfarin.
## Clinical Pearls
* Cefixime is poorly absorbed systemically from the GI tract and is primarily used for local effects, particularly in the genitourinary and gastrointestinal tracts. However, it is generally considered effective for systemic infections when appropriate indications are met.
* Suspension requires reconstitution. Shake well before use. Store reconstituted suspension in the refrigerator and discard after 14 days.
* Prophylactic use for uncomplicated gonorrhea is an accepted alternative regimen.
* Consider a change in therapy if clinical improvement is not observed within 2-3 days.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and current clinical guidelines for the most up-to-date and complete drug information. Verify dosages and recommendations with local institutional protocols.*
