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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 typically administered orally.
## Primary Indications
* Acute otitis media
* Pharyngitis/tonsillitis
* Uncomplicated urinary tract infections
* Acute exacerbations of chronic bronchitis
* Uncomplicated gonorrhea (due to Neisseria gonorrhoeae)
## Adult Dosing
* **General:** 400 mg orally once daily or 200 mg every 12 hours.
* **Uncomplicated gonorrhea:** 400 mg orally as a single dose.
* Maximum daily dose: 400 mg.
## Pediatric Dosing
* **General:** 8 mg/kg/day orally once daily or 4 mg/kg every 12 hours.
* **Maximum daily dose:** 400 mg.
* Dosing depends on weight and indication; specific protocols may vary.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 60 mL/min: No adjustment needed.
* CrCl 30-60 mL/min: 200 mg every 12 hours OR 400 mg once daily.
* CrCl < 30 mL/min: 200 mg once daily OR 200 mg every 24 hours.
* Hemodialysis or peritoneal dialysis patients: 200 mg once daily OR 200 mg every 24 hours.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or penicillin.
## Adverse Effects
* Common: Diarrhea, nausea, vomiting, abdominal pain, headache.
* Less common: Rash, dizziness, eosinophilia, thrombocytopenia.
* Serious: Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridioides difficile-associated diarrhea.
## Key Drug Interactions
* **Warfarin:** May increase INR. Monitor INR closely.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels.
* **Probenecid:** May increase cefixime plasma concentrations.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of C. difficile infection.
* Monitor renal function, especially in patients with decreased renal function or those receiving concurrent nephrotoxic agents.
## Clinical Pearls
* Cefixime is not recommended for the treatment of *Staphylococcus aureus* infections.
* Ensure adequate hydration when treating sinusitis or bronchitis to aid expectoration.
* Treatment duration typically ranges from 5 to 14 days, depending on the infection.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and product monograph before making clinical decisions.*
