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# Cefixime (Genixim)
## Overview
Cefixime is a third-generation cephalosporin antibiotic. It possesses broad-spectrum activity against Gram-negative bacteria (including *Neisseria gonorrhoeae*, *Haemophilus influenzae*, and *Moraxella catarrhalis*) but is generally less effective against Gram-positive organisms (e.g., *Staphylococcus*) than first-generation cephalosporins.
## Primary Indications
* Uncomplicated gonorrhea (cervical, urethral, and rectal).
* Otitis media.
* Pharyngitis and tonsillitis.
* Acute bronchitis and acute exacerbations of chronic bronchitis.
* Uncomplicated urinary tract infections (UTIs).
## Adult Dosing
* **Gonorrhea:** 800 mg orally as a single dose.
* **Respiratory/UTI/Other:** 400 mg daily, administered either as a single dose or in two divided doses of 200 mg every 12 hours.
## Pediatric Dosing
* **General infections (>6 months):** 8 mg/kg/day orally, administered as a single daily dose or in two divided doses every 12 hours.
* **Maximum pediatric dose:** 400 mg/day.
* **Note:** Confirm age/weight appropriateness; safety and efficacy in infants <6 months have not been established.
## Dose Adjustments
* **Renal Impairment (CrCl 21–60 mL/min):** Reduce the dose by 25% (or administer 75% of the standard dose).
* **Renal Impairment (CrCl <20 mL/min):** Reduce the dose by 50% (or administer 50% of the standard dose).
* **Hemodialysis/Peritoneal Dialysis:** No significant removal reported; standard adjustments for severe renal impairment apply.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of severe allergic reaction (anaphylaxis) to penicillins or other beta-lactams.
## Adverse Effects
* **Common:** Diarrhea (frequently dose-related), abdominal pain, nausea, dyspepsia, and flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome), and elevated liver enzymes.
## Key Drug Interactions
* **Anticoagulants:** May enhance the effect of Vitamin K antagonists (e.g., warfarin); monitor INR.
* **Probenecid:** May increase serum concentrations of cefixime by inhibiting renal excretion.
* **Carbamazepine:** Rare reports of elevated carbamazepine levels with concomitant use.
## Monitoring
* Monitor for signs of hypersensitivity and CDAD (persistent diarrhea).
* Assess renal function periodically in patients on long-term therapy or higher doses.
## Clinical Pearls
* **GI Distress:** Diarrhea is a frequent side effect; consider taking the medication with food if gastrointestinal upset occurs, though absorption is largely unaffected.
* **Gonorrhea Resistance:** Due to rising *N. gonorrhoeae* resistance, cefixime should only be used as a primary agent if susceptibility is confirmed or per current local CDC/public health treatment guidelines (often used in combination with azithromycin or doxycycline if PID is suspected).
* **Formulation:** Tablet and oral suspension formulations are not strictly bioequivalent milligram-for-milligram in all markets; verify the specific product labeling.
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**Educational Disclaimer:** This information is provided for educational purposes only. Clinical guidelines and local antimicrobial stewardship protocols vary based on geography and resistance patterns. Always verify current prescribing information, dosing, and contraindications against the manufacturer's official labeling, institutional formulary, or local infectious disease guidelines before prescribing or administering medication.
