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# Cefixime trihydrate
## Overview
Cefixime is a third-generation cephalosporin antibiotic effective against many Gram-positive and Gram-negative bacteria. It is administered orally and penetrates tissues well.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs) due to susceptible organisms (e.g., *Escherichia coli, Proteus mirabilis*).
* Acute otitis media (AOM) in pediatric patients due to susceptible organisms (e.g., *Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes*).
* Pharyngitis/tonsillitis due to *Streptococcus pyogenes*.
* Acute bronchitis and acute exacerbations of chronic bronchitis due to susceptible organisms.
* Uncomplicated gonorrhea (cervical or urethral infections) due to *Neisseria gonorrhoeae*.
## Adult Dosing
* **Uncomplicated UTIs, acute bronchitis, pharyngitis/tonsillitis:** 400 mg orally once daily or 200 mg orally every 12 hours. Duration is typically 5-14 days depending on indication.
* **Uncomplicated gonorrhea:** 400 mg orally as a single dose.
* **Maximum dose:** 400 mg once daily.
## Pediatric Dosing
* **Age < 6 months:** Safety and efficacy not established.
* **Age ≥ 6 months:**
* **General infections (e.g., AOM, pharyngitis/tonsillitis):** 8 mg/kg orally once daily or 4 mg/kg orally every 12 hours.
* **Maximum dose:** 400 mg once daily.
* Dosing for pediatric UTIs depends on local protocol and may differ.
## Dose Adjustments
* **Renal Impairment:**
* Creatinine clearance > 60 mL/min: No adjustment needed.
* Creatinine clearance 31-60 mL/min: Standard dose can be given.
* Creatinine clearance 11-30 mL/min: Reduce daily dose by 25% or give standard dose every 24 hours.
* Creatinine clearance < 10 mL/min (or on hemodialysis): Reduce daily dose by 50% or give standard dose every 48 hours.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of immediate and severe reactions (anaphylaxis, Stevens-Johnson syndrome) to penicillin or other beta-lactam drugs.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, abdominal pain, headache, rash.
Less Common: Allergic reactions (including anaphylaxis), *Clostridioides difficile*-associated diarrhea, thrombocytopenia, eosinophilia, elevated liver enzymes, neutropenia, leukopenia.
## Key Drug Interactions
* **Warfarin:** May increase the effect of warfarin. Monitor INR closely.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels.
* **BCG vaccine:** Cephalosporins may reduce the efficacy of BCG vaccine. Discontinue cefixime at least 3 days before BCG vaccination.
## Monitoring
* Monitor for signs and symptoms of allergic reactions.
* Monitor for gastrointestinal disturbances, especially *C. difficile*-associated diarrhea.
* Monitor renal function in patients with renal impairment.
* Monitor prothrombin time/INR when co-administered with warfarin.
## Clinical Pearls
* Cefixime has good oral bioavailability and can be dosed once daily for many indications
