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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.
## Primary Indications
* Acute otitis media
* Urinary tract infections (uncomplicated)
* Pharyngitis/tonsillitis
* Acute exacerbations of chronic bronchitis
## Adult Dosing
* **General:** 400 mg orally once daily or 200 mg orally every 12 hours.
* **Maximum:** 400 mg per day.
* **Duration:** Varies by indication, typically 5-14 days.
## Pediatric Dosing
* **General (oral suspension):** 8 mg/kg/day given once daily or in two divided doses (4 mg/kg every 12 hours).
* **Maximum:** 400 mg per day.
* **Age:** Typically used for children > 6 months of age. Dosing for infants < 6 months is not well established.
## Dose Adjustments
* **Renal Impairment:**
* CrCl ≥ 60 mL/min: No adjustment needed.
* CrCl 30-59 mL/min: 400 mg daily (or 200 mg q12h) can be given. Consideration may be given to standard dosing frequency.
* CrCl < 30 mL/min: 200 mg daily (or 100 mg q12h).
* Hemodialysis/Peritoneal Dialysis: 200 mg daily (or 100 mg q12h).
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, penicillins, or any component of the formulation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache.
* **Serious (rare):** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, hepatic dysfunction, renal dysfunction, seizures (rare, especially with renal impairment).
## Key Drug Interactions
* **Warfarin:** May increase INR. Monitor INR closely.
* **Probenecid:** May increase cefixime plasma concentrations.
* **Carbamazepine:** May increase carbamazepine levels. Monitor carbamazepine levels.
* **BCG Vaccine:** Cephalosporins may reduce the efficacy of BCG vaccines. Do not administer cefixime until at least 3 days after BCG vaccination.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea, especially if severe or persistent, to rule out *C. difficile*-associated diarrhea.
* Renal function in patients with pre-existing renal impairment or those receiving concurrent nephrotoxic agents.
## Clinical Pearls
* Administer orally. Can be taken with or without food.
* Ensure adequate hydration, especially in children receiving oral suspension.
* Use with caution in patients with a history of gastrointestinal disease, particularly colitis.
* Consider the spectrum of activity when choosing cefixime for empiric therapy.
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*Disclaimer: This information is intended for healthcare professionals. Prescribing decisions should always be based on current, official prescribing information and individual patient factors. Local protocols may also influence dosing and management.*
