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# Cefixime (Suprax)
## Overview
Cefixime is a third-generation cephalosporin antibiotic. It possesses broad-spectrum activity against Gram-negative bacteria (e.g., *Haemophilus influenzae*, *Moraxella catarrhalis*, *Neisseria gonorrhoeae*) and limited activity against Gram-positive organisms.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Acute bronchitis and acute exacerbations of chronic bronchitis
* Uncomplicated gonorrhea (cervical, urethral, and rectal)
## Adult Dosing
* **General infections:** 400 mg daily, administered either as a single dose or divided as 200 mg every 12 hours.
* **Uncomplicated gonorrhea:** 800 mg orally as a single dose (note: CDC guidelines currently prefer ceftriaxone injection, but cefixime remains an alternative).
## Pediatric Dosing
* **General infections (>6 months):** 8 mg/kg/day orally, either as a single dose or divided every 12 hours.
* **Maximum:** 400 mg daily.
* **Note:** Always verify dosing based on local institutional weight-based protocols.
## Dose Adjustments
* **Renal Impairment:** Adjustments required for CrCl <60 mL/min.
* CrCl 21–60 mL/min: Reduce dose by 25% (or 300 mg daily).
* CrCl <20 mL/min: Reduce dose by 50% (or 200 mg daily).
* **Hepatic Impairment:** No standard dosage adjustment established.
## Contraindications
* Hypersensitivity to cefixime or other cephalosporins.
* History of severe allergic reactions (anaphylaxis/Stevens-Johnson syndrome) to penicillins or other beta-lactams.
## Adverse Effects
* **Common:** Diarrhea (frequent), abdominal pain, nausea, dyspepsia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (rash, urticaria), seizures (rare, associated with renal impairment/overdose).
## Key Drug Interactions
* **Anticoagulants:** May increase the anticoagulant effect of warfarin (vitamin K synthesis inhibition). Monitor INR.
* **Live Vaccines:** Cefixime may decrease the efficacy of the typhoid vaccine; avoid concomitant use.
* **Probenecid:** May increase serum concentrations of cefixime by inhibiting renal tubular secretion.
## Monitoring
* Monitor for signs of hypersensitivity.
* Monitor renal function in patients on long-term therapy or with preexisting impairment.
* Assess for persistent diarrhea to rule out *C. difficile* infection.
## Clinical Pearls
* **Bioavailability:** Suspension has higher bioavailability than tablets; consider this if switching formulations.
* **No Gram-positive coverage:** Cefixime has poor activity against *Staphylococcus aureus*; do not use for suspected Staphylococcal infections.
* **Diarrhea:** GI side effects are dose-dependent; if diarrhea is severe, advise patient to contact a provider immediately.
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*Disclaimer: This information is for educational purposes and does not replace professional medical judgment. Always verify current prescribing information, institutional guidelines, and drug-drug interaction databases before prescribing or administering medication.*
