Tab Cefixime

# Tab cefixime ## Overview - **Classification**: Cephalosporin antibiotic, 3rd generation - **Mechanism**: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to cell lysis and death. ## Primary Indications 1. **Acute Otitis Media (AOM)** - Bacterial ear infection. 2. **Pharyngitis/Tonsillitis** - Group A Streptococcal infection. 3. **Acute Exacerbations of Chronic Bronchitis (AECB)** - Bacterial respiratory infection. 4. **Uncomplicated Urinary Tract Infections (UTIs)** - Cystitis. 5. **Uncomplicated Gonorrhea** - Specific strains susceptible. ## Adult Dosing ### Standard Dosing **Most Infections (AOM, Pharyngitis, AECB, UTI)** - **Dose**: **400 mg** - **Frequency**: Once daily (every 24 hours) OR **200 mg** every 12 hours - **Route**: Oral - **Duration**: 5-10 days, depending on infection and clinical response **Uncomplicated Gonorrhea** - **Dose**: **400 mg** - **Frequency**: Single dose - **Route**: Oral ### Dose Adjustments - **Renal Impairment**: - CrCl > 60 mL/min: No adjustment needed. - CrCl 21-60 mL/min: **300 mg** PO once daily. - CrCl < 20 mL/min (including hemodialysis/CAPD): **200 mg** PO once daily. - **Hepatic Impairment**: No specific dose adjustment recommended. - **Elderly Patients**: Adjust based on renal function; no age-specific adjustment needed. ## Pediatric Dosing ### Neonates (0-28 days) - **Not routinely recommended**: Limited safety and efficacy data. - **Special Notes**: Use other cephalosporins or discuss with infectious disease specialist if needed. ### Infants (1-12 months) - **Dose**: **8 mg/kg/day** - **Frequency**: Once daily OR divided every 12 hours - **Maximum**: **400 mg/day** - **Formulation**: Oral suspension is preferred. ### Children (1-12 years) - **Dose**: **8 mg/kg/day** - **Frequency**: Once daily OR divided every 12 hours - **Maximum**: **400 mg/day** (or adult dose for older children) - **Formulation**: Oral suspension or chewable tablets (if available). ### Adolescents (13-18 years) - **Dose**: Typically adult dosing applies. - **Frequency**: Once daily OR divided every 12 hours - **Maximum**: **400 mg/day** ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to cefixime or other cephalosporins. - **Absolute**: History of severe hypersensitivity (e.g., anaphylaxis) to penicillin. ### Common Adverse Effects - **Very Common (>10%)**: Diarrhea. - **Common (1-10%)**: Nausea, abdominal pain, dyspepsia, flatulence, headache, dizziness. - **Serious but Rare**: *Clostridioides difficile*-associated diarrhea (CDAD), Stevens-Johnson syndrome, toxic epidermal necrolysis, severe allergic reactions (anaphylaxis), hemolytic anemia. ### Key Drug Interactions - **Oral Anticoagulants (e.g., warfarin)**: May increase INR and bleeding risk. Monitor INR closely; adjust anticoagulant dose as needed. - **Carbamazepine**: Cefixime may increase carbamazepine levels. Monitor carbamazepine levels if co-administered. - **Probenecid**: May increase cefixime serum concentrations. Generally not clinically significant. ## Monitoring & Follow-up - **Before Treatment**: Assess renal function (CrCl). - **During Treatment**: Monitor for resolution of infection symptoms. - **Clinical Signs**: Watch for severe or persistent diarrhea (CDAD), rash, or other signs of allergic reaction. ## Clinical Pearls - 💡 **Administration**: Can be taken with or without food; food may reduce GI upset. - 💡 **Suspension**: Reconstituted oral suspension must be refrigerated and discarded after **14 days**. - 💡 **Spectrum**: Not active against *Pseudomonas* species or most MRSA strains. - 💡 **Compliance**: Counsel patients to complete the full course to prevent resistance. - 💡 **Lab Interference**: May cause false-positive direct Coombs' test. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.