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# Tabgenixim (Cefixime) ## Overview Cefixime is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs). It possesses broad-spectrum activity against many Gram-negative organisms, including *Haemophilus influenzae*, *Moraxella catarrhalis*, and *Neisseria gonorrhoeae*, but has limited activity against Gram-positives and anaerobes. ## Primary Indications * Uncomplicated gonorrhea (urethral, endocervical, and rectal). * Otitis media (acute). * Pharyngitis and tonsillitis. * Acute bronchitis and acute exacerbations of chronic bronchitis. * Uncomplicated urinary tract infections. ## Adult Dosing * **Uncomplicated Gonorrhea:** 800 mg orally as a single dose. * **Other Infections:** 400 mg orally once daily or 200 mg orally every 12 hours. * **Note:** Oral suspension may have increased bioavailability compared to tablets; ensure consistent formulation use. ## Pediatric Dosing * **General Infections (Age > 6 months):** 8 mg/kg/day orally as a single daily dose or divided every 12 hours. * **Maximum Dose:** 400 mg/day. * **Note:** Safety and efficacy in infants < 6 months have not been established. ## Dose Adjustments * **Renal Impairment (CrCl 21–60 mL/min):** Reduce dose to 75% of the standard dose. * **Renal Impairment (CrCl < 20 mL/min):** Reduce dose to 50% of the standard dose. * **Hemodialysis/Peritoneal Dialysis:** No supplemental dose required; remain at 50% of standard dose. ## Contraindications * Known hypersensitivity to cefixime or other cephalosporins. * History of severe allergic reactions (e.g., anaphylaxis) to penicillins or other beta-lactams due to potential cross-reactivity. ## Adverse Effects * **Common:** Diarrhea (most common), abdominal pain, nausea, dyspepsia. * **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis), and hematologic abnormalities (leukopenia, thrombocytopenia). ## Key Drug Interactions * **Antacids/Magnesium/Aluminum Hydroxide:** May decrease the rate of absorption. Administer at least 2 hours apart. * **Warfarin:** May enhance the anticoagulant effect by depleting vitamin K-producing flora; monitor INR closely. ## Monitoring * Monitor for signs of hypersensitivity, especially with initial doses. * Assess for persistent diarrhea (rule out CDAD). * Renal function (creatinine clearance) in patients with known impairment or prolonged therapy. ## Clinical Pearls * Cefixime is NOT a first-line treatment for syphilis; if patient has suspected co-infection, ensure follow-up testing. * Oral suspension must be shaken well before each use. * Efficacy against *Streptococcus pneumoniae* is inconsistent; avoid for suspected pneumococcal pneumonia. * Bioavailability of the oral suspension is approximately 5–10% higher than the tablet; consider this during transitions between formulations. *** **Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Please consult current prescribing information (FDA labels, etc.), institutional antimicrobial stewardship protocols, and pharmacy resources before prescribing or administering medication. Confirm weight-based calculations and organ function status in every patient.