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# Cefixime Trihydrate
## Overview
Cefixime is a third-generation cephalosporin antibiotic. It is administered orally and has broad-spectrum activity against many Gram-positive and Gram-negative bacteria.
## Primary Indications
* **Acute otitis media**
* **Acute bronchitis** (exacerbations)
* **Pharyngitis/tonsillitis**
* **Uncomplicated urinary tract infections**
## Adult Dosing
* **General:** 400 mg orally once daily or 200 mg orally every 12 hours.
* **Maximum:** 400 mg per day.
* **Duration:** Varies by indication, typically 5-14 days.
## Pediatric Dosing
* **General:** 8 mg/kg/day orally once daily or 4 mg/kg/dose every 12 hours.
* **Maximum:** 400 mg per day.
* **Age:** Generally for children 6 months and older. Dosing for younger infants is less established and may depend on local protocols.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is recommended for patients with creatinine clearance (CrCl) less than 30 mL/min.
* CrCl 30-60 mL/min: 400 mg once daily or 200 mg every 12 hours.
* CrCl < 30 mL/min: 200 mg once daily or 100 mg every 12 hours.
* Hemodialysis patients: 200 mg once daily or 100 mg every 12 hours, with a supplemental dose after each dialysis session.
## 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.
* **Serious:** *Clostridioides difficile*-associated diarrhea, severe hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis), seizures (rare), hemolytic anemia, neutropenia, thrombocytopenia, increased liver enzymes, renal dysfunction.
## Key Drug Interactions
* **Warfarin:** May increase INR. Monitor INR closely.
* **Carbamazepine:** May increase carbamazepine levels. Monitor carbamazepine levels.
* **BCG Vaccine:** Decreased efficacy. Avoid concurrent use.
* **Probenecid:** May increase cefixime levels.
## Monitoring
* Signs and symptoms of infection.
* Stool for *C. difficile* if diarrhea is prolonged or severe.
* Renal function, especially in patients with pre-existing renal impairment or those receiving nephrotoxic agents.
* Allergic reactions.
## Clinical Pearls
* Administer with or without food.
* Oral suspension should be reconstituted with the amount of water specified by the manufacturer and shaken well before each use. Discard after the recommended storage period.
* Consider prescribing a probiotic for patients at risk for diarrhea, especially *C. difficile*.
* Ensure adequate hydration.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making clinical decisions. The exact dosing and management may vary based on patient-specific factors and local institutional protocols.
