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# Cefixime trihydrate
## Overview
Cefixime trihydrate is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria. It is administered orally.
## Primary Indications
* Acute bacterial exacerbations of chronic bronchitis
* Acute otitis media
* Uncomplicated gonorrhea
* Urinary tract infections (uncomplicated)
## Adult Dosing
* **General:** 400 mg orally once daily.
* **Uncomplicated gonorrhea:** 400 mg orally as a single dose.
* **Duration of therapy:** Typically 5-10 days, depending on the indication and clinical response.
## Pediatric Dosing
* **Age > 6 months:** 8 mg/kg orally once daily, not to exceed 400 mg/day.
* **Duration of therapy:** Typically 5-10 days, depending on the indication and clinical response.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is generally not required in patients with mild to moderate renal impairment. For severe renal impairment (CrCl < 30 mL/min), the recommended dose is 200 mg once daily.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of immediate-type hypersensitivity reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, seizures (rare).
## Key Drug Interactions
* **Warfarin:** May increase the effect of warfarin, potentially leading to an increased risk of bleeding. Monitor INR closely.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine concentrations.
## Monitoring
* Assess for signs and symptoms of hypersensitivity reactions.
* Monitor for effectiveness of treatment (resolution of infection).
* Monitor for adverse effects, particularly gastrointestinal disturbances and *C. difficile* infection.
* Consider renal function monitoring in patients with severe renal impairment.
## Clinical Pearls
* Cefixime trihydrate provides convenient once-daily dosing.
* It is effective against common pathogens causing UTIs, respiratory infections, and gonorrhea.
* Cross-reactivity with penicillins is possible, though less common with third-generation cephalosporins. Use with caution in patients with a history of severe penicillin allergy.
**Disclaimer:** This information is intended for clinicians and is not a substitute for professional medical advice. Always consult the most current prescribing information and local institutional protocols before making treatment decisions.
