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# Cefixime trihydrate
## Overview
Cefixime trihydrate is a third-generation cephalosporin antibiotic effective against a variety of gram-positive and gram-negative bacteria. It is administered orally.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Acute otitis media
* Acute exacerbations of chronic bronchitis
* Pharyngitis/tonsillitis
* Uncomplicated gonorrhea
## Adult Dosing
* **General:** 400 mg orally once daily, or 200 mg orally every 12 hours.
* **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:** 400 mg daily.
* Dosing for infants < 6 months is not well established.
## Dose Adjustments
* **Renal Impairment:**
* If creatinine clearance (CrCl) > 60 mL/min: No dose adjustment needed.
* If CrCl 31-60 mL/min: Administer usual dose.
* If CrCl 11-30 mL/min: 200 mg orally once daily (or 100 mg every 12 hours).
* If CrCl < 11 mL/min (or on hemodialysis): 200 mg orally once daily (or 100 mg every 12 hours).
* If on continuous ambulatory peritoneal dialysis (CAPD): 200 mg orally once daily (or 100 mg every 12 hours).
## Contraindications
* Known 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, vomiting, abdominal pain, headache.
* **Serious:**
* Hypersensitivity reactions (anaphylaxis, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis)
* Clostridioides difficile-associated diarrhea (CDAD)
* Seizures (rare)
* Hepatitis, cholestatic jaundice
* Acute renal failure
## Key Drug Interactions
* **Warfarin:** Monitor INR closely as cefixime may increase the effect of warfarin.
* **Probenecid:** May increase cefixime serum concentrations.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels.
* **Nephrotoxic agents (e.g., aminoglycosides, diuretics):** Increased risk of nephrotoxicity.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Assess for diarrhea and rule out C. difficile infection.
* Monitor renal function in patients with pre-existing renal impairment or those receiving concurrent nephrotoxic agents.
* Monitor INR if co-administered with warfarin.
## Clinical Pearls
* Administer with or without food.
* Shake oral suspension well before use.
* Discontinue if hypersensitivity reaction occurs.
* Use with caution in patients with a history of gastrointestinal disease, particularly colitis.
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*Disclaimer: This information is intended for healthcare professionals. Always verify current prescribing information with the official drug product labeling and consult with a qualified healthcare provider.*
