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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
* Uncomplicated urinary tract infections (UTIs) caused by susceptible strains of *Escherichia coli, Proteus mirabilis, Staphylococcus aureus, Streptococcus pyogenes*, and *Streptococcus agalactiae*.
* Otitis media caused by susceptible strains of *Haemophilus influenzae, Moraxella catarrhalis*, and *Streptococcus pyogenes*.
* Pharyngitis/tonsillitis caused by susceptible strains of *Streptococcus pyogenes*.
* Acute bronchitis and acute exacerbations of chronic bronchitis caused by susceptible strains of *Haemophilus influenzae, Moraxella catarrhalis*, and *Streptococcus pyogenes*.
* Uncomplicated gonorrhea (cervical/urethral infections) caused by susceptible strains of *Neisseria gonorrhoeae*.
## Adult Dosing
* **General Dosing:** 400 mg orally once daily or 200 mg orally every 12 hours.
* **Uncomplicated Gonorrhea:** 400 mg orally single dose.
* **Maximum Dose:** 400 mg per day.
## Pediatric Dosing
* **General Dosing:** 8 mg/kg orally once daily or 4 mg/kg orally every 12 hours.
* **Maximum Pediatric Dose:** 400 mg per day.
* **Note:** For otitis media, pharyngitis, or uncomplicated UTIs, dosing may be adjusted based on local protocols. Dosing for children under 6 months of age is not established.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 60 mL/min: No adjustment needed.
* CrCl 31-60 mL/min: Same as above or reduce dose by 25%.
* CrCl 11-30 mL/min: 400 mg once daily or 200 mg every 12 hours, or reduce dose by 25%. If given every 12 hours, give every 18 hours.
* CrCl < 10 mL/min (including hemodialysis patients): 200 mg once daily or 100 mg every 12 hours, or reduce dose by 25%. If given every 12 hours, give every 24 hours. It is not efficiently removed by hemodialysis.
* **Hepatic Impairment:** No specific dosage adjustment recommended.
## Contraindications
* Known hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of immediate and severe hypersensitivity reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, abdominal pain, nausea, vomiting, dyspepsia, flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea, severe hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis), seizure, hemolytic anemia, neutropenia, thrombocytopenia, leukopenia, eosinophilia, elevated liver enzymes, renal dysfunction.
## Key Drug Interactions
* **Warfarin:** May increase the effect of warfarin, leading to an increased risk of bleeding. Monitor INR closely.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels.
* **BCG Vaccine:** Avoid concurrent use.
* **Probenecid:** May increase cefixime AUC.
## Monitoring
* Assess for signs and symptoms of allergic reactions.
* Monitor bowel function for *Clostridioides difficile* infection.
* Monitor renal function in patients with impaired renal function.
* Monitor INR if patient is on warfarin concurrently.
* Monitor carbamazepine levels if patient is on carbamazepine concurrently.
## Clinical Pearls
* Cefixime is a convenient option for once-daily dosing for many indications.
* It is not effective against *Pseudomonas aeruginosa* or enterococci.
* Discontinue immediately if a serious allergic reaction occurs.
* Diarrhea is a common side effect; however, *C. difficile*-associated diarrhea should be considered if diarrhea is severe or persistent.
* Ensure adequate hydration, especially in pediatric patients.
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*Disclaimer: This information is intended for healthcare professionals and does not replace individual clinical judgment or the need to consult official prescribing information and current guidelines. Always verify current prescribing information before use.*
