Please check your internet connection and try again.
# 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 and is primarily used for infections caused by susceptible organisms.
## Primary Indications
* Acute otitis media (AOM)
* Acute exacerbations of chronic bronchitis (AECB)
* Uncomplicated urinary tract infections (UTIs)
* Pharyngitis/tonsillitis
* Uncomplicated gonorrhea
## Adult Dosing
* **General Dosing:** 400 mg orally once daily or 200 mg orally every 12 hours.
* **Uncomplicated Gonorrhea:** 400 mg orally as a single dose.
* **Maximum Dose:** 400 mg daily.
## Pediatric Dosing
* **General Dosing:** 8 mg/kg/day orally once daily or divided into 4 mg/kg every 12 hours.
* **Maximum Dose:** 400 mg daily.
* **AOM:** May use 8 mg/kg/day once daily for up to 10 days.
* **Note:** For children weighing >45 kg, use the adult dose. The 8 mg/kg/day dose is an estimate; precise dosing may depend on local protocols and specific guidelines.
## Dose Adjustments
* **Renal Impairment:**
* If creatinine clearance (CrCl) is >60 mL/min: No dose adjustment needed.
* If CrCl is 31-60 mL/min: No dose adjustment needed.
* If CrCl is 11-30 mL/min: Administer 200 mg once daily or 100 mg every 12 hours.
* If CrCl is <10 mL/min or on hemodialysis: Administer 200 mg once daily or 100 mg every 12 hours. Consider dose adjustment every other day for patients on continuous ambulatory peritoneal dialysis (CAPD).
## 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, vomiting, abdominal pain, headache, dizziness.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, seizure, hepatic dysfunction, renal dysfunction, hematologic changes (eosinophilia, leukopenia, thrombocytopenia).
## Key Drug Interactions
* **Warfarin:** May increase the anticoagulant effect of warfarin. Monitor INR closely.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels.
* **Tetanus Toxoid Vaccine:** Cefixime may reduce the immunogenic response to tetanus toxoid vaccine.
* **BCG Vaccine:** Concurrent use with cephalosporins may blunt the immune response to BCG.
## Monitoring
* Assess for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea; if severe or persistent, consider CDAD.
* Evaluate renal function in patients with impaired renal function or those receiving concomitant nephrotoxic drugs.
* Monitor stool for blood or mucus.
## Clinical Pearls
* Cefixime is not effective against *Pseudomonas aeruginosa* or *Enterococcus* species.
* It is generally not recommended for use in patients with severe renal impairment unless dose is adjusted.
* Due to potential for diarrhea, use cautiously in patients with a history of gastrointestinal issues.
* Consider patient's history of allergies, especially to penicillins and cephalosporins.
***
**Disclaimer:** This information is for educational purposes only and does not substitute professional medical advice. Always verify current prescribing information, guidelines, and local protocols before making any clinical decisions.
