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# Cefixime Trihydrate
## Overview
Cefixime trihydrate is a third-generation cephalosporin antibiotic effective against a variety of Gram-positive and Gram-negative bacteria. It is administered orally.
## Primary Indications
* Acute otitis media
* Acute bronchitis and acute exacerbations of chronic bronchitis
* Uncomplicated urinary tract infections (UTIs)
* Pharyngitis/tonsillitis
* Uncomplicated gonorrhea
## Adult Dosing
* **General:** 400 mg once daily or 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** A single 400 mg dose.
* Maximum dose: 400 mg daily.
## Pediatric Dosing
* **Age < 6 months:** Safety and efficacy not established.
* **Age ≥ 6 months:** 8 mg/kg/day once daily or 4 mg/kg/dose every 12 hours.
* **Maximum dose:** 400 mg daily.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 60 mL/min: No adjustment needed.
* CrCl 21-60 mL/min or in patients on regular hemodialysis: 400 mg daily or 200 mg every 12 hours.
* CrCl < 20 mL/min or in patients on chronic ambulatory peritoneal dialysis: 200 mg daily or 100 mg every 12 hours.
* With peritoneal dialysis, dose may need adjustment based on fluid removal and drug clearance. Local protocols should be consulted.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
## Adverse Effects
* **Common:** Diarrhea, nausea, abdominal pain, vomiting, headache.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, renal impairment, hepatic impairment, seizures (rare).
## Key Drug Interactions
* **Warfarin:** May alter prothrombin time. Monitor INR.
* **Nephrotoxic drugs (e.g., aminoglycosides, vancomycin, diuretics):** Increased risk of nephrotoxicity. Use with caution and monitor renal function.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels.
* **Probenecid:** May increase cefixime levels.
## Monitoring
* Signs and symptoms of bacterial infection during therapy and for a period after completion.
* Signs and symptoms of hypersensitivity reactions.
* Bowel function for *C. difficile*-associated diarrhea.
* Renal function, especially in elderly patients or those with pre-existing renal impairment.
## Clinical Pearls
* Cefixime is not generally recommended for empiric treatment of community-acquired pneumonia where *Streptococcus pneumoniae* is a likely pathogen due to suboptimal coverage.
* The liquid suspension may require reconstitution; follow manufacturer instructions carefully regarding preparation and storage. Discard after the specified period (often 10-14 days).
* Consider efficacy against beta-lactamase producing organisms when selecting cefixime.
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*Disclaimer: This information is intended for clinical pharmacists and prescribers. It is essential to consult the most current prescribing information and relevant guidelines for definitive dosing, indications, and safety considerations.*
