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# Cefixime trihydrate
## Overview
Cefixime trihydrate 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 exacerbations of chronic bronchitis
* Acute uncomplicated urinary tract infections
* Uncomplicated gonorrhea
## Adult Dosing
* **General:** 400 mg orally once daily or 200 mg orally every 12 hours.
* **Uncomplicated Gonorrhea:** 400 mg orally as a single dose.
## Pediatric Dosing
* **General:** 8 mg/kg/day orally once daily or 4 mg/kg/dose every 12 hours.
* **Maximum:** Not to exceed the adult dose of 400 mg/day.
* Dosing for children under 6 months is not established.
## Dose Adjustments
* **Renal Impairment:** Adjust dose based on creatinine clearance (CrCl).
* CrCl 30-40 mL/min: 300 mg once daily or 150 mg every 12 hours.
* CrCl 11-29 mL/min: 200 mg once daily or 100 mg every 12 hours.
* CrCl <10 mL/min or undergoing intermittent hemodialysis: 200 mg once daily or 100 mg every 12 hours. Patients on hemodialysis should receive the same dose every 24 hours.
## 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, abdominal pain, vomiting, headache.
* **Serious:** Hypersensitivity reactions (including Stevens-Johnson syndrome, toxic epidermal necrolysis), C. difficile-associated diarrhea, seizures (rare), hepatic dysfunction, renal dysfunction.
## Key Drug Interactions
* **Warfarin:** May increase INR. Monitor INR closely.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels.
* **Probenecid:** May increase cefixime levels.
* **BCG vaccines:** Cephalosporins may decrease the efficacy of BCG vaccines.
## Monitoring
* Monitor for signs of hypersensitivity reactions and C. difficile-associated diarrhea.
* Assess for clinical improvement of infection.
* Monitor renal function in patients with pre-existing renal impairment or those receiving concurrent nephrotoxic agents.
## Clinical Pearls
* Administer with or without food.
* Shake oral suspension well before each use.
* Ensure adequate hydration to prevent crystalluria.
**Disclaimer:** This information is intended for clinical decision-making and does not substitute for professional medical advice. Always consult the most current prescribing information and local guidelines for complete details.
