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# Cefixime
## Overview
Cefixime is a third-generation cephalosporin antibiotic. It is administered orally and exhibits bactericidal activity by inhibiting bacterial cell wall synthesis. It is stable in the presence of many beta-lactamase enzymes, providing enhanced activity against Gram-negative organisms compared to earlier cephalosporins.
## Primary Indications
* Acute otitis media (AOM)
* Pharyngitis and tonsillitis
* Uncomplicated urinary tract infections (UTIs)
* Uncomplicated gonorrhea (cervical, urethral, and rectal)
* Acute exacerbations of chronic bronchitis
## Adult Dosing
* **General infections:** 400 mg daily, administered either as a single dose or in two divided doses (200 mg every 12 hours).
* **Uncomplicated gonorrhea:** 800 mg orally as a single dose.
## Pediatric Dosing
* **General infections:** 8 mg/kg/day orally, administered as a single dose or in two divided doses (4 mg/kg every 12 hours).
* **Max dose:** 400 mg per day.
* **Note:** Pediatric dosing is weight-based for patients >6 months of age.
## Dose Adjustments
* **Renal Impairment:** Adjustments are required for patients with a creatinine clearance (CrCl) <60 mL/min.
* CrCl 21–60 mL/min: Reduce dose to 75% of the standard dose.
* CrCl <20 mL/min: Reduce dose to 50% of the standard dose.
* **Hepatic Impairment:** No formal dosage adjustments are established by the manufacturer.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of anaphylaxis to penicillins or other beta-lactam antibiotics (due to potential for cross-reactivity).
## Adverse Effects
* **Common:** Diarrhea, abdominal pain, nausea, dyspepsia, flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity reactions (anaphylaxis), Stevens-Johnson syndrome, and hemolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., Warfarin):** May increase the risk of bleeding due to potential alteration of gut flora and vitamin K synthesis. Monitor INR.
* **Probenecid:** May elevate cefixime serum concentrations by inhibiting renal tubular secretion.
## Monitoring
* Monitor for signs of hypersensitivity, especially at the start of therapy.
* Monitor stool frequency and consistency to detect potential *C. difficile* infection.
* In prolonged therapy, assess renal, hepatic, and hematologic functions.
## Clinical Pearls
* Cefixime suspension and tablet formulations are not necessarily bioequivalent; refer to local pharmacy/formulary guidelines when substituting.
* Take with food if gastrointestinal distress occurs, though it may be administered without regard to meals.
* Cefixime lacks reliable activity against *Staphylococcus aureus* and is not indicated for empiric coverage of typical skin and soft tissue pathogens.
* Always confirm local susceptibility patterns (antibiograms) for common pathogens (e.g., *E. coli* or *N. gonorrhoeae*) before prescribing.
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**Educational Disclaimer:** This information is for educational purposes only. Always verify drug dosages, contraindications, and clinical guidelines using current, official prescribing information (e.g., FDA-approved product labels, clinical databases like Lexicomp or UpToDate) and local institutional protocols before prescribing or administering medication.
