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# Cefixime trihydrate
## Overview
Cefixime is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria. It is administered orally.
## Primary Indications
* Acute otitis media
* Uncomplicated urinary tract infections
* Pharyngitis/tonsillitis
* Acute bronchitis and acute exacerbations of chronic bronchitis
* Uncomplicated gonorrhea (cervical/urethral infections)
## 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 dose:** Generally 400 mg per day.
## Pediatric Dosing
* **General:** Dosing is typically based on weight. Common recommendations range from 8 mg/kg/day given once daily or in two divided doses.
* **Maximum dose:** Maximum daily dose should not exceed the adult maximum of 400 mg/day.
* **Note:** Specific dosing may vary by indication and age group; consult product labeling or local protocols. Oral suspension reconstitution instructions must be followed.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is recommended for patients with severe renal impairment (creatinine clearance < 30 mL/min). A typical adjustment is 200 mg every 24 hours (or 100 mg every 12 hours for those previously on 200 mg every 12 hours). For patients on hemodialysis or continuous peritoneal dialysis, a typical dose is 400 mg every 24 hours or 200 mg every 24 hours, with supplemental doses after dialysis if needed.
## Contraindications
* Known hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of immediate and severe hypersensitivity (anaphylaxis) to penicillin or other beta-lactam drugs.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, dyspepsia.
* **Less Common:** Headache, dizziness, rash, pruritus, urticaria.
* **Serious:** Clostridium difficile-associated diarrhea (CDAD), severe allergic reactions (anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis), hepatotoxicity, nephrotoxicity, seizures (rare).
## Key Drug Interactions
* **Warfarin:** Monitor INR closely as cefixime may increase the effect of warfarin.
* **Carbamazepine:** Cefixime may increase carbamazepine levels. Monitor carbamazepine levels and adjust dose if necessary.
* **Probenecid:** May increase cefixime plasma concentrations.
* **BCG vaccine:** Cephalosporins may decrease the efficacy of the BCG vaccine. Defer vaccination until 3 days after cefixime therapy is completed.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of C. difficile infection (e.g., watery diarrhea, abdominal cramping).
* For patients with renal impairment, monitor renal function.
* If co-administered with warfarin, monitor INR.
## Clinical Pearls
* Administer with or without food.
* Ensure adequate hydration, especially in pediatric patients, to prevent crystalluria.
* Consider the spectrum of activity when selecting cefixime; it may not be appropriate for all bacterial infections.
* A significant cross-hypersensitivity exists between penicillins and cephalosporins, although it is less common than previously thought. Use with caution in patients with a history of 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 complete drug details, including indications, contraindications, warnings, precautions, drug interactions, and adverse reactions, before making clinical decisions.*
