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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
* Uncomplicated urinary tract infections (UTIs) caused by susceptible *Escherichia coli*, *Proteus mirabilis*, *Klebsiella* species, or *Streptococcus (Enterococcus) faecalis*.
* Acute otitis media caused by susceptible *Haemophilus influenzae* (beta-lactamase positive and negative strains), *Moraxella catarrhalis* (most strains), or *Streptococcus pyogenes*.
* Pharyngitis and tonsillitis caused by susceptible *Streptococcus pyogenes*.
* Acute exacerbations of chronic bronchitis caused by susceptible *Haemophilus influenzae* (beta-lactamase positive and negative strains), *Moraxella catarrhalis* (most strains), or *Streptococcus pneumoniae*.
## Adult Dosing
* **Standard Dose:** 400 mg orally once daily, or 200 mg orally every 12 hours.
* **Maximum Dose:** 400 mg daily.
* Duration of treatment depends on the indication, typically 5 to 14 days.
## Pediatric Dosing
* **Children 6 months to 12 years:** 8 mg/kg orally once daily or 4 mg/kg orally every 12 hours.
* **Maximum Pediatric Dose:** 400 mg daily.
* **Children over 12 years:** Dosing as per adult guidelines.
* **Infants under 6 months:** Safety and efficacy not established.
## Dose Adjustments
* **Renal Impairment:**
* If creatinine clearance (CrCl) is > 60 mL/min: No dose adjustment needed.
* If CrCl is 30-60 mL/min: Administer usual dose every 24 hours.
* If CrCl is < 30 mL/min: Administer usual dose every 48 hours.
* For patients on intermittent hemodialysis or peritoneal dialysis: Administer usual dose every 48 hours.
## Contraindications
* Hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of severe immediate hypersensitivity reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, abdominal pain, vomiting, headache, rash.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, seizures (rare), hemolytic anemia.
## Key Drug Interactions
* **Probenecid:** May increase cefixime levels.
* **Warfarin:** Monitor INR as cefixime may potentiate anticoagulant effects.
* **Carbamazepine:** Cefixime may increase carbamazepine levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions and *C. difficile*-associated diarrhea.
* Monitor renal function, especially in patients with pre-existing renal impairment or those receiving concomitant nephrotoxic agents.
* Monitor prothrombin time in patients receiving anticoagulants.
## Clinical Pearls
* Cefixime is not effective against *Pseudomonas aeruginosa*.
* It is generally considered safe for patients with a history of mild penicillin allergy, but caution is advised in those with severe penicillin allergies due to potential cross-reactivity.
* Absorption is not significantly affected by food.
* Oral suspensions should be reconstituted with the specified amount of water and shaken well before each use.
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*Disclaimer: This information is for educational purposes and should not replace current prescribing information. Always consult the official drug monograph and local protocols for the most up-to-date and comprehensive guidance.*
