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# Cefixime trihydrate
## Overview
Cefixime is a third-generation oral cephalosporin with broad-spectrum activity against many Gram-positive and Gram-negative bacteria. It is bactericidal, inhibiting bacterial cell wall synthesis.
## Primary Indications
* Acute bacterial otitis media
* Acute bacterial sinusitis
* Acute exacerbations of chronic bronchitis
* Uncomplicated urinary tract infections (UTIs)
* Treatment of infections caused by susceptible strains of *Haemophilus influenzae*, *Streptococcus pyogenes*, *Streptococcus pneumoniae*, *Moraxella catarrhalis*, and *Escherichia coli*.
## Adult Dosing
* **General:** 400 mg orally once daily or 200 mg orally every 12 hours.
* **Maximum:** 400 mg per day.
* **Duration:** Typically 5-10 days, depending on the infection and local guidelines.
## Pediatric Dosing
* **General:** 8 mg/kg/day orally once daily or 4 mg/kg/every 12 hours.
* **Maximum:** 400 mg per day.
* **Age:** Generally for children >6 months of age. For infants <6 months, data is limited, and caution is advised.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is recommended for patients with significant renal impairment.
* Creatinine clearance (CrCl) 30-60 mL/min: Usual dose.
* CrCl <30 mL/min: Half the usual dose, given once daily.
* Hemodialysis/Peritoneal dialysis: Half the usual dose, given once daily.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of immediate hypersensitivity reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia, headache.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome/toxic epidermal necrolysis, seizures (rare), hepatic dysfunction, renal dysfunction.
## Key Drug Interactions
* **Probenecid:** May decrease renal excretion of cefixime, increasing serum levels.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels.
* **Warfarin:** Cases of increased INR with warfarin and cefixime have been reported. Monitor INR.
* **Oral contraceptives:** Reduced efficacy of oral contraceptives is possible, though data is limited. Consider alternative contraception.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs of *Clostridioides difficile*-associated diarrhea.
* Monitor renal function, especially in patients with pre-existing renal impairment or those receiving concomitant nephrotoxic agents.
* Monitor INR if co-administered with warfarin.
## Clinical Pearls
* Cefixime is not recommended for the treatment of *Streptococcus pneumoniae* pneumonia due to insufficient resistance rates.
* Ensure adequate hydration when taking cefixime to minimize the risk of crystalluria.
* Cefixime powder for oral suspension should be reconstituted according to manufacturer instructions and stored in the refrigerator. Discard unused portion after 14 days.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local institutional protocols before initiating or modifying therapy.
