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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 organisms.
* Otitis media (middle ear infection) caused by susceptible organisms.
* Pharyngitis/tonsillitis caused by susceptible organisms.
* Acute exacerbations of chronic bronchitis or acute bronchitis caused by susceptible organisms.
* Uncomplicated gonorrhea (single dose).
## Adult Dosing
* **General Dosing:** 400 mg once daily or 400 mg divided into two 200 mg doses every 12 hours.
* **Uncomplicated Gonorrhea:** 400 mg orally as a single dose.
* **Maximum Dose:** Generally 400 mg per day unless otherwise specified by local protocol for specific indications.
## Pediatric Dosing
* **General Dosing:** 8 mg/kg/day once daily or 4 mg/kg every 12 hours.
* **Maximum Dose:** 400 mg per day.
* **Note:** Dosing may vary based on the specific indication and age of the child. Consult product labeling or local guidelines. For otitis media, a total daily dose of 8 mg/kg is often recommended.
## Dose Adjustments
* **Renal Impairment:** Dose reduction may be necessary in severe renal impairment (creatinine clearance < 30 mL/min). For adults not undergoing dialysis, the recommended dose is 200 mg every 24 hours. For patients on dialysis, including CAPD, the recommended dose is 200 mg every 24 hours. Further adjustment may be needed based on severity.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of severe immediate hypersensitivity reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache, dizziness.
* **Less Common:** Rash, pruritus, dysgeusia, allergic reactions, eosinophilia, leukopenia, thrombocytopenia, transient elevations in liver enzymes and BUN.
* **Serious:** Severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis), clostridium difficile-associated diarrhea (CDAD), anaphylaxis, seizures (rare).
## Key Drug Interactions
* **Warfarin:** Monitor INR closely as cefixime may increase the anticoagulant effect of warfarin.
* **Probenecid:** May increase cefixime plasma concentrations.
* **Carbamazepine:** May increase carbamazepine levels.
* **Oral contraceptives:** Efficacy of oral contraceptives may be reduced.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs of secondary infections (e.g., fungal overgrowth).
* Monitor stool for C. difficile.
* Renal function in patients with impaired renal function or those on nephrotoxic agents.
## Clinical Pearls
* Administer with or without food.
* Shake oral suspension well before use.
* Ensure adequate hydration in patients experiencing diarrhea.
* Use with caution in patients with a history of gastrointestinal disease, especially colitis.
* Culture and sensitivity testing should be done when appropriate to determine the causative organism and its susceptibility.
*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.*
