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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 has good bioavailability.
## Primary Indications
* Acute otitis media
* Acute bacterial sinusitis
* Acute exacerbations of chronic bronchitis
* Uncomplicated urinary tract infections
## Adult Dosing
* **Standard Dose:** 400 mg orally once daily or 200 mg orally every 12 hours.
* **Maximum Dose:** 400 mg per day.
## Pediatric Dosing
* **Age < 6 months:** Safety and efficacy not established.
* **Age ≥ 6 months:** 8 mg/kg orally once daily or 4 mg/kg orally every 12 hours.
* **Maximum Pediatric Dose:** 400 mg per day.
## Dose Adjustments
* **Renal Impairment:**
* CrCl ≥ 60 mL/min: No adjustment needed.
* CrCl 30-59 mL/min: 400 mg once daily or 200 mg every 12 hours.
* CrCl 11-29 mL/min: 200 mg once daily.
* CrCl ≤ 10 mL/min or undergoing hemodialysis: 200 mg once daily or 100 mg every 12 hours. Dose should be administered after hemodialysis.
## Contraindications
* Known hypersensitivity to cefixime, other cephalosporins, penicillins, or other beta-lactam drugs.
## Adverse Effects
Common adverse effects include diarrhea, nausea, abdominal pain, vomiting, and headache. Serious adverse effects can include Clostridioides difficile-associated diarrhea, Stevens-Johnson syndrome, toxic epidermal necrolysis, and hypersensitivity reactions.
## Key Drug Interactions
* **Warfarin:** May increase INR. Monitor INR closely.
* **BCG vaccines:** Cephalosporins may decrease the efficacy of BCG vaccines. Discontinue cefixime at least 3 days before BCG vaccination.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of Clostridioides difficile infection.
* Monitor renal function in patients with renal impairment.
## Clinical Pearls
* Cefixime is available as oral suspension and capsules/tablets.
* The oral suspension should be refrigerated and discarded after 14 days.
* While generally well-tolerated, cephalosporin allergy is a contraindication.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete drug details before making any treatment decisions.
