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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
* Acute otitis media
* Acute bacterial exacerbations of chronic bronchitis
* Acute, uncomplicated urinary tract infections
* Uncomplicated gonorrhea (cervical or urethral infection)
* Pharyngitis/tonsillitis (due to susceptible *Streptococcus pyogenes*)
## Adult Dosing
* **Most indications:** 400 mg orally once daily or 200 mg orally every 12 hours.
* **Uncomplicated urinary tract infections:** 400 mg orally once daily.
* **Uncomplicated gonorrhea:** 400 mg orally as a single dose.
* **Maximum dose:** Generally 400 mg per day.
## Pediatric Dosing
* **Most indications (children > 6 months):** 8 mg/kg orally once daily or 4 mg/kg orally every 12 hours.
* **Maximum dose:** Generally 400 mg per day, regardless of weight.
* Dosing for children less than 6 months is not established.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is recommended if the creatinine clearance (CrCl) is less than 30 mL/min.
* For patients on once-daily dosing: Administer the usual dose every 24 hours.
* For patients on twice-daily dosing: Administer the usual dose every 24 hours.
* If CrCl is less than 10 mL/min and the patient is not on dialysis: Consider reducing the dose by 50%.
* **Hemodialysis:** No dose adjustment is typically needed; however, patients on chronic hemodialysis may require supplemental dosing after dialysis.
## Contraindications
* Known hypersensitivity to cefixime, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* History of immediate or severe allergic reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia, headache.
* **Serious:** Hypersensitivity reactions (including anaphylaxis), *Clostridioides difficile*-associated diarrhea (CDAD), Stevens-Johnson syndrome, toxic epidermal necrolysis, hepatic dysfunction, renal dysfunction, seizures (rare), hemolytic anemia.
## Key Drug Interactions
* **Warfarin:** Monitor INR closely as cefixime may increase the anticoagulant effect.
* **Carbamazepine:** Cefixime may increase carbamazepine levels; monitor carbamazepine levels.
* **Probenecid:** May increase cefixime plasma concentrations.
* **BCG Vaccine:** Reduced efficacy. Avoid concurrent use.
## Monitoring
* Assess for signs and symptoms of hypersensitivity reactions.
* Monitor for the development of *C. difficile*-associated diarrhea.
* Assess renal function, especially in patients with pre-existing renal impairment or those receiving other nephrotoxic agents.
* Monitor prothrombin time (PT) and international normalized ratio (INR) in patients receiving warfarin.
## Clinical Pearls
* Administer with or without food for improved tolerability, but taking with food may enhance absorption.
* Ensure adequate hydration to prevent crystalluria.
* Cefixime is generally not active against *Enterococcus* species, *Staphylococcus aureus*, or *Pseudomonas aeruginosa*.
* For pharyngitis, ensure adequate treatment duration to eradicate *Streptococcus pyogenes*.
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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 and updated details before making any treatment decisions.*
