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Cefixime trihydrate is a third-generation cephalosporin antibiotic.
## Overview
Cefixime is a broad-spectrum oral antibiotic effective against many Gram-positive and Gram-negative bacteria. It is bacteriocidal, inhibiting bacterial cell wall synthesis.
## Primary Indications
* Acute otitis media
* Urinary tract infections (uncomplicated)
* Pharyngitis/tonsillitis (due to *Streptococcus pyogenes*)
* Acute exacerbations of chronic bronchitis
* Cervical/urethral gonorrhea (uncomplicated)
## Adult Dosing
* **General:** 400 mg orally once daily, or 200 mg orally every 12 hours.
* **Gonorrhea:** 400 mg orally as a single dose.
* **Maximum:** 400 mg once daily.
## Pediatric Dosing
* **General (≥ 6 months):** 8 mg/kg orally once daily, or 4 mg/kg orally every 12 hours.
* **Maximum:** 400 mg once daily.
* Dosing for children < 6 months is not established.
## Dose Adjustments
No dose adjustment is typically required for hepatic impairment. Dose adjustment is generally not needed in renal impairment unless creatinine clearance is less than 30 mL/min. In that case, the usual dose should be given every 24 hours, or half the usual dose every 12 hours.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of severe immediate hypersensitivity reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache, dizziness.
* **Serious:** *Clostridioides difficile*-associated diarrhea, severe hypersensitivity reactions (anaphylaxis), Stevens-Johnson syndrome/toxic epidermal necrolysis, seizures (rare, particularly with renal impairment).
## Key Drug Interactions
* **Probenecid:** May increase cefixime plasma concentrations.
* **Warfarin:** Monitor INR closely as cefixime may decrease prothrombin time.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for efficacy and development of resistance.
* Monitor for *Clostridioides difficile* infection, especially with prolonged use or severe diarrhea.
* Monitor renal function if other nephrotoxic agents are used concurrently or in patients with pre-existing renal impairment.
## Clinical Pearls
* Administer with or without food.
* Oral suspension should be reconstituted according to package directions and stored refrigerated; discard after 14 days.
* Not effective against *Staphylococcus aureus* causing skin and soft tissue infections.
* Due to potential for cross-reactivity, use with caution in patients with penicillin allergy, especially immediate or anaphylactic reactions.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current official prescribing information and your institution's guidelines for complete and up-to-date dosing and safety information.
