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# Cefixime trihydrate
## Overview
Cefixime trihydrate is a third-generation cephalosporin antibiotic effective against a wide range of Gram-positive and Gram-negative bacteria. It is administered orally.
## Primary Indications
* Acute bacterial otitis media
* Acute bacterial sinusitis
* Acute exacerbations of chronic bronchitis
* Uncomplicated urinary tract infections
* Uncomplicated gonorrhea (cervical or urethral infections)
## Adult Dosing
* **Most indications:** 400 mg orally once daily, or 200 mg orally every 12 hours.
* **Uncomplicated gonorrhea:** 400 mg orally as a single dose.
* **Maximum daily dose:** 400 mg.
## Pediatric Dosing
* **Acute bacterial otitis media, acute bacterial sinusitis, and acute exacerbations of chronic bronchitis:** 8 mg/kg orally once daily, or 4 mg/kg orally every 12 hours.
* **Maximum daily dose:** 400 mg.
* **Note:** Dosing for children under 6 months is not established.
## Dose Adjustments
* **Renal Impairment:**
* For patients with moderate renal impairment (creatinine clearance 30-60 mL/min) or those on continuous ambulatory peritoneal dialysis (CAPD), the usual adult dose of 400 mg once daily may be given as 200 mg every 12 hours.
* For patients with severe renal impairment (creatinine clearance <30 mL/min) or those undergoing hemodialysis (which is less effective than CAPD), the dose should be reduced. Standard pediatric dosing or 200 mg every 24 hours is often recommended, but exact dosing may depend on local protocol or prescriber judgment.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of immediate and severe allergic reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, abdominal pain, vomiting, headache, dizziness, rash.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea (CDAD), Stevens-Johnson syndrome, toxic epidermal necrolysis, seizures (rare, particularly in patients with renal impairment), hemolytic anemia, neutropenia, thrombocytopenia.
## Key Drug Interactions
* **Warfarin:** May increase the effect of warfarin; monitor INR.
* **Carbamazepine:** Cefixime may increase carbamazepine levels; monitor carbamazepine levels.
* **Probenecid:** May increase cefixime levels.
## Monitoring
* Monitor for signs and symptoms of allergic reactions.
* Monitor bowel function for diarrhea. If severe or persistent diarrhea occurs, consider C. difficile infection.
* Monitor renal function, especially in elderly patients or those with pre-existing renal disease.
* For patients with gonorrhea, test for cure approximately 2-3 weeks after treatment.
## Clinical Pearls
* Cefixime can be taken with or without food.
* Swallow capsules or tablets whole; do not crush or chew.
* Shake oral suspension well before measuring a dose.
* Treatment duration depends on the type and severity of infection. Complete the full course of therapy even if symptoms improve.
* Use with caution in patients with a history of gastrointestinal disease, especially colitis.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant guidelines for complete and up-to-date details before making any clinical decisions. Dosing and recommendations can vary based on individual patient factors and local protocols.
