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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 and is generally well-tolerated.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs) due to susceptible *Escherichia coli*, *Proteus mirabilis*, *Klebsiella pneumoniae*, or *Enterococcus faecalis*.
* Otitis media due to susceptible *Haemophilus influenzae*, *Moraxella catarrhalis*, or *Streptococcus pyogenes*.
* Pharyngitis/tonsillitis due to susceptible *Streptococcus pyogenes*.
* Acute exacerbations of chronic bronchitis or acute bronchitis due to susceptible *Haemophilus influenzae*, *Moraxella catarrhalis*, or *Streptococcus pneumoniae*.
## Adult Dosing
* **General:** 400 mg orally once daily or 200 mg orally every 12 hours.
* **Maximum:** 400 mg daily.
## Pediatric Dosing
* **General:** 8 mg/kg orally once daily or 4 mg/kg orally every 12 hours.
* **Maximum:** 400 mg daily. For otitis media, some guidelines suggest higher doses up to 16 mg/kg/day divided every 12 hours. Pediatric dosing may depend on local protocol.
## Dose Adjustments
* **Renal Impairment:**
* **CrCl > 60 mL/min:** No adjustment necessary.
* **CrCl 30-60 mL/min:** 200 mg orally once daily or 100 mg orally every 12 hours.
* **CrCl < 30 mL/min:** 200 mg orally once daily or 100 mg orally every 12 hours (for once daily dosing), or 100 mg orally every 24 hours (for twice daily dosing).
* **Hemodialysis:** Reduce dose by 50% and administer after hemodialysis.
* **Continuous peritoneal dialysis:** Reduce dose by 50%.
## Contraindications
* Known hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of immediate and severe allergic reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, seizures (rare), pancytopenia, hemolytic anemia.
## Key Drug Interactions
* **Warfarin:** May increase INR. Monitor INR closely.
* **Probenecid:** May increase cefixime plasma levels.
* **Carbamazepine:** May increase carbamazepine levels. Monitor carbamazepine levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea, especially if severe or persistent (> CDAD).
* Monitor renal function periodically in patients with renal impairment.
* Monitor INR in patients taking warfarin concurrently.
## Clinical Pearls
* Cefixime is not effective against *Pseudomonas aeruginosa*.
* Use with caution in patients with a history of penicillin allergy, although cross-reactivity is less common with third-generation cephalosporins compared to earlier generations.
* Ensure adequate hydration when reconstituting oral suspension. Do not refrigerate reconstituted oral suspension; discard after 14 days.
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**Disclaimer:** This information is intended for clinical decision support and does not replace professional judgment. Always consult the most current prescribing information and relevant guidelines for complete details and to verify dosages and safety information.
