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# Cefixime (Suprax)
## Overview
Cefixime is a third-generation cephalosporin antibiotic. It possesses broad-spectrum activity against many Gram-negative bacteria and increased stability against beta-lactamases compared to earlier generations, though it has limited activity against *Staphylococcus aureus*.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Gonococcal infections (uncomplicated)
* Acute exacerbations of chronic bronchitis
## Adult Dosing
* **Standard 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.
## Pediatric Dosing
* **Children (>6 months):** 8 mg/kg/day, administered as a single daily dose or in two divided doses of 4 mg/kg every 12 hours.
* **Maximum daily dose:** 400 mg.
## Dose Adjustments
* **Renal Impairment:**
* CrCl 21–60 mL/min: Reduce dose to 75% of the standard regimen.
* CrCl <20 mL/min: Reduce dose to 50% of the standard regimen.
* **Hepatic Impairment:** No specific adjustments defined; use with caution.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporin antibiotics.
* History of severe hypersensitivity (e.g., anaphylaxis) to penicillins or other beta-lactams (due to cross-reactivity).
## Adverse Effects
* **Common:** Diarrhea (most common), abdominal pain, nausea, dyspepsia, and flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (rash, urticaria, serum sickness), and rare cases of Stevens-Johnson syndrome or toxic epidermal necrolysis.
## Key Drug Interactions
* **Warfarin/Anticoagulants:** May increase the anticoagulant effect (monitor INR).
* **Probenecid:** May elevate serum concentrations of cefixime by inhibiting renal tubular secretion.
* **Oral Contraceptives:** Potential for reduced efficacy (mechanism debated, but barrier backup is often recommended).
## Monitoring
* **Clinical:** Resolution of infection symptoms.
* **Safety:** Monitor for signs of *C. difficile* infection (persistent diarrhea/cramping) and hypersensitivity reactions.
* **Labs:** For prolonged therapy, monitor renal and hepatic function, and perform periodic CBC.
## Clinical Pearls
* **Bioavailability:** Suspension has higher bioavailability than the tablet formulation; they are not strictly interchangeable on a mg-per-mg basis in all clinical contexts.
* **Spectrum:** Cefixime is largely ineffective against *Pseudomonas aeruginosa* and methicillin-resistant *Staphylococcus aureus* (MRSA).
* **Administration:** May be taken with or without food.
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**Educational Disclaimer:** This information is for educational purposes only. Dosing, contraindications, and drug interactions can vary significantly based on patient-specific factors, local resistance patterns, and institutional guidelines. Always consult the most recent product monograph and verify all doses with a pharmacist or current clinical reference before prescribing or administering medication.
