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# Cefixime trihydrate
## Overview
Cefixime trihydrate is a third-generation cephalosporin antibiotic effective against a broad spectrum of Gram-negative and some Gram-positive bacteria. It is administered orally.
## Primary Indications
* Acute otitis media
* Urinary tract infections (uncomplicated)
* Pharyngitis/tonsillitis
* Acute bronchitis and acute exacerbations of chronic bronchitis
* 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.
* **Maximum:** 400 mg per day.
## Pediatric Dosing
* **General:** 8 mg/kg/day orally once daily or 4 mg/kg/dose orally every 12 hours.
* **Maximum:** 400 mg/day.
* Dosing is weight-based and should be adjusted according to clinical judgment and local protocols.
## Dose Adjustments
* **Renal Impairment:** Dose reduction is recommended for patients with severe renal impairment (creatinine clearance < 30 mL/min). Adjustments are typically based on local protocols, but a common recommendation is to halve the usual daily dose. Hemodialysis patients may require dose adjustments.
## Contraindications
* Known hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of severe immediate hypersensitivity reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia, headache.
* **Serious:** Severe allergic reactions (anaphylaxis), Clostridioides difficile-associated diarrhea (CDAD), Stevens-Johnson syndrome, toxic epidermal necrolysis, seizure, hepatic dysfunction, renal dysfunction, hemolytic anemia.
## Key Drug Interactions
* **Warfarin:** May increase the effect of warfarin, leading to an increased risk of bleeding. Monitor INR closely.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels.
* **BCG Vaccine:** Concomitant use may reduce the efficacy of the BCG vaccine. Avoid concurrent administration and postpone BCG vaccination for at least 14 days after cefixime discontinuation.
## Monitoring
* Assess for signs and symptoms of infection for which the drug is prescribed.
* Monitor for adverse effects, particularly diarrhea.
* Monitor renal function, especially in patients with pre-existing renal impairment or those receiving other nephrotoxic agents.
* Monitor INR if co-administered with warfarin.
* Monitor carbamazepine levels if co-administered.
## Clinical Pearls
* Cefixime is often used for community-acquired infections due to its broad spectrum and convenient dosing.
* Ensure adequate hydration and avoid antidiarrheal agents if CDAD is suspected.
* Cross-reactivity with penicillins can occur; exercise caution in patients with a history of severe penicillin allergy.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and local institutional guidelines for definitive patient care decisions.*
