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# Cefixime trihydrate
## Overview
Cefixime is a third-generation cephalosporin antibiotic. It is available as oral capsules and suspensions.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs) caused by susceptible strains of *Escherichia coli*, *Klebsiella pneumoniae*, and *Proteus mirabilis*.
* Otitis media caused by susceptible strains of *Haemophilus influenzae*, *Moraxella catarrhalis* (beta-lactamase producing strains included), and *Streptococcus pyogenes*.
* Pharyngitis/tonsillitis caused by susceptible strains of *Streptococcus pyogenes*.
* Acute exacerbations of chronic bronchitis caused by susceptible strains of *Haemophilus influenzae*, *Moraxella catarrhalis* (beta-lactamase producing strains included), and *Streptococcus pneumoniae*.
* Uncomplicated gonorrhea (cervical/urethral) caused by *Neisseria gonorrhoeae*.
## Adult Dosing
* **UTI, Otitis Media, Bronchitis, Pharyngitis:** 400 mg once daily or 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** A single dose of 400 mg.
* Maximum dose is typically 400 mg daily for all indications. Specific dosing for certain populations may vary based on local protocols.
## Pediatric Dosing
* **General Use (excluding otitis media):** 8 mg/kg/day once daily or 4 mg/kg every 12 hours. Maximum daily dose is 400 mg.
* **Otitis Media, Acute Bacterial Sinusitis, or Pharyngitis (for children < 12 years or weighing < 50 kg):** 8 mg/kg/day once daily. Maximum daily dose is 400 mg.
* **General Use (for children weighing > 50 kg or > 12 years):** Use adult dosing.
* Dosing for neonates and infants younger than 6 months is not established.
## Dose Adjustments
No dose adjustment is typically required for renal impairment unless severe (creatinine clearance < 30 mL/min). In such cases, the once-daily dose should be given every 24 hours, and the every-12-hour dose should be given every 12 hours.
## Contraindications
* Hypersensitivity to cefixime or other cephalosporins.
* History of severe immediate hypersensitivity reaction to penicillin.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, abdominal pain, and headache. Serious adverse effects may include anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridioides difficile-associated diarrhea, and seizure.
## Key Drug Interactions
* **Warfarin:** Cefixime may enhance the effect of warfarin, increasing the risk of bleeding. Monitor INR closely.
* **Other highly protein-bound drugs:** Increased risk of displacement and potential toxicity.
## Monitoring
* Monitor for signs and symptoms of allergic reaction.
* Monitor for diarrhea; discontinue if severe.
* Monitor renal function in patients with pre-existing renal impairment.
* Monitor INR if concomitantly using warfarin.
## Clinical Pearls
* Cefixime has good oral bioavailability and can be dosed once daily for many indications.
* It is active against many gram-negative organisms, including some beta-lactamase producing strains.
* Due to potential for cross-reactivity, caution is advised in patients with penicillin allergy.
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***Disclaimer:** This information is intended for clinical pharmacist use and is not a substitute for current prescribing information. Always consult the official product monograph or reliable drug information resources for complete and up-to-date guidance before making therapeutic decisions.*
