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# Cefixime trihydrate
## Overview
Cefixime trihydrate is a third-generation cephalosporin antibiotic. It is active against a range of Gram-positive and Gram-negative bacteria.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media (ear infections)
* 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.
## Pediatric Dosing
* **General:** 8 mg/kg orally once daily, or 4 mg/kg orally every 12 hours.
* **Maximum Dose:** 400 mg/day for all pediatric patients.
* **Otitis Media:** 8 mg/kg orally once daily, or 4 mg/kg orally every 12 hours. Dosing duration may vary based on local guidelines and indication.
## Dose Adjustments
* **Renal Impairment:** If creatinine clearance is < 60 mL/min, the recommended dose is 200 mg once daily (or 100 mg every 12 hours for adults). For pediatric patients, adjust based on weight and renal function, consulting specific pediatric dosing guidelines.
## Contraindications
* Known hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
## Adverse Effects
* **Common:** Diarrhea, nausea, abdominal pain, vomiting, dyspepsia, headache.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, seizure, hepatic dysfunction, renal dysfunction.
## Key Drug Interactions
* **Warfarin:** Increased INR and bleeding risk. Monitor INR closely.
* **Carbamazepine:** Increased carbamazepine levels. Monitor carbamazepine levels.
* **Probenecid:** May increase cefixime plasma concentrations.
* **BCG Vaccine:** Reduced efficacy. Avoid concomitant use.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea, especially *C. difficile*-associated diarrhea.
* For patients on warfarin, monitor INR.
* For patients on carbamazepine, monitor carbamazepine levels.
* Renal function should be assessed in patients with renal impairment.
## Clinical Pearls
* Administer with or without food.
* Ensure adequate hydration in patients receiving cefixime, especially pediatric patients.
* Consider the local antimicrobial resistance patterns when prescribing.
* Cefixime is not typically the first-line agent for *Streptococcus pyogenes* pharyngitis due to potential for higher treatment failures compared to penicillin.
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant guidelines for definitive patient care decisions. Dosing and recommendations may vary based on local protocols and individual patient factors.*
