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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.
## Primary Indications
* Acute bacterial otitis media
* Acute bacterial sinusitis
* Acute exacerbations of chronic bronchitis
* Uncomplicated urinary tract infections (UTIs)
* Uncomplicated gonorrhea
## Adult Dosing
* **General:** 400 mg once daily, or 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** 400 mg as a single dose.
* **Maximum:** 400 mg daily.
## Pediatric Dosing
* **General:** 8 mg/kg/day once daily or 4 mg/kg/dose every 12 hours.
* **Maximum:** 400 mg daily.
* Dosing for children under 6 months of age is not established. Careful consideration is warranted for this age group.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 60 mL/min: No adjustment needed.
* CrCl 30-60 mL/min: 400 mg once daily or 200 mg every 12 hours.
* CrCl < 30 mL/min: 200 mg once daily or 100 mg every 12 hours.
* Hemodialysis: 200 mg once daily or 100 mg every 12 hours.
* **Hepatic Impairment:** No dose adjustment generally recommended. Local protocols may vary.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of immediate and/or severe allergic reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (including anaphylaxis, Stevens-Johnson syndrome, erythema multiforme), seizure, blood dyscrasias, hepatotoxicity, nephrotoxicity.
## Key Drug Interactions
* **Warfarin:** May increase INR. Monitor INR closely.
* **Carbamazepine:** May increase carbamazepine levels. Monitor carbamazepine levels.
* **BCG Vaccine:** Reduced efficacy. Avoid concurrent use.
* **Probenecid:** May increase cefixime levels.
## Monitoring
* Assess for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea; differentiate from CDAD.
* Renal function and electrolytes in patients with significant renal impairment or receiving concomitant nephrotoxic agents.
* Periodic assessment of hematopoietic function with prolonged therapy.
## Clinical Pearls
* Administer with or without food.
* Shake oral suspension well before use.
* Ensure adequate hydration to prevent crystalluria.
* Consider alternative agents if *C. difficile* infection is suspected.
* Consider potential for cross-reactivity in patients with penicillin allergy, though the risk is lower with later-generation cephalosporins.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and local institutional guidelines for complete and up-to-date drug information.*
