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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 otitis media
* Acute exacerbations of chronic bronchitis
* Acute uncomplicated urinary tract infections
* Uncomplicated gonorrhea (cervical/urethral and rectal infections)
* Shigellosis
* Salmonellosis
## Adult Dosing
* **General Dosing:** 400 mg once daily or 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** 400 mg as a single dose.
* **Maximum Dose:** 400 mg once daily.
## Pediatric Dosing
* **General Dosing:** 8 mg/kg/day once daily or 4 mg/kg every 12 hours.
* **Maximum Dose:** 400 mg/day. Dosing for children under 6 months is not well established.
## Dose Adjustments
* **Renal Impairment:**
* Creatinine clearance (CrCl) > 60 mL/min: No dose 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.
* Patients on hemodialysis: 400 mg or 200 mg once daily (depending on severity of infection) reduced by 30% when given at the time of dialysis, and may be administered every 24 hours instead of 12 hours.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of immediate and severe hypersensitivity reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, rash.
* **Serious:** Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridioides difficile-associated diarrhea, hepatotoxicity, renal toxicity, seizures (rare).
## Key Drug Interactions
* **Warfarin:** May potentiate the effect of warfarin. Monitor INR.
* **Probenecid:** May increase cefixime serum concentrations.
* **Carbamazepine:** May increase carbamazepine levels. Monitor carbamazepine levels.
## Monitoring
* Monitor for signs of hypersensitivity reactions.
* Monitor for signs and symptoms of C. difficile-associated diarrhea.
* Monitor renal function in patients with pre-existing renal impairment or when used concurrently with nephrotoxic agents.
* Monitor INR if used with warfarin.
## Clinical Pearls
* Cefixime is not typically effective against Enterococcus species or Pseudomonas aeruginosa.
* It can be administered with or without food.
* Due to resistance patterns, it may not be the preferred agent for Strep. pneumoniae.
* Culture and sensitivity testing should be done when appropriate to guide therapy.
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**Disclaimer:** This information is intended for clinical professionals. Always consult the most current prescribing information and institutional protocols before making treatment decisions.
