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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 and is generally well-tolerated.
## Primary Indications
* Acute bacterial exacerbations of chronic bronchitis
* Acute otitis media
* Urinary tract infections
* Pharyngitis/tonsillitis caused by susceptible *Streptococcus pyogenes*
* Uncomplicated gonorrhea
## Adult Dosing
* **General infections:** 400 mg orally once daily or 200 mg orally every 12 hours.
* **Uncomplicated gonorrhea:** 400 mg orally as a single dose.
* **Maximum dose:** 400 mg per day.
## Pediatric Dosing
* **Children 6 months and older:** 8 mg/kg orally once daily or 4 mg/kg orally every 12 hours.
* **Maximum dose:** 400 mg per day.
* Dosing for children under 6 months is not established.
## Dose Adjustments
* **Renal impairment:**
* CrCl > 60 mL/min: No dose adjustment needed.
* CrCl 21-60 mL/min: 400 mg once daily or 200 mg every 12 hours.
* CrCl < 20 mL/min (including hemodialysis patients): 200 mg once daily or 100 mg every 12 hours.
* **Hepatic impairment:** No dose adjustment is typically necessary.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of immediate or severe allergic reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, hemolytic anemia.
## Key Drug Interactions
* **Warfarin:** May increase INR. Monitor INR closely.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels.
* **BCG vaccines:** Cefixime may reduce the efficacy of BCG vaccines. Discontinue cefixime and consult manufacturer recommendations for BCG administration timing.
## Monitoring
* Discontinue if hypersensitivity reaction occurs.
* Monitor for signs and symptoms of *Clostridioides difficile*-associated diarrhea.
* Monitor renal function in patients with impaired renal function.
## Clinical Pearls
* Administer with or without food.
* Suspensions should be shaken well before use.
* Prolonged use may result in fungal or bacterial superinfection.
* Resistance can develop; use appropriate diagnostic tests to identify the causative organism and determine susceptibility.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and relevant guidelines for complete details before making any treatment decisions.
