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# Cefixime (Genixim)
## 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. It is stable against many beta-lactamases.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Uncomplicated gonorrhea (cervical, urethral, rectal)
* Acute exacerbations of chronic bronchitis
## Adult Dosing
* **General infections:** 400 mg daily, administered as a single dose or in two divided doses (200 mg BID).
* **Uncomplicated Gonorrhea:** 800 mg orally as a single dose.
## Pediatric Dosing
* **Children >6 months:** 8 mg/kg/day orally, administered as a single dose or in two divided doses (4 mg/kg BID).
* **Maximum pediatric dose:** 400 mg/day.
## Dose Adjustments
* **Renal Impairment:** If CrCl <60 mL/min/1.73m², dose reduction may be required. Generally, for CrCl 21–60 mL/min, reduce dose to 75% of standard. For CrCl <20 mL/min, reduce dose to 50% of standard. Adjustments vary by local protocol; refer to specific renal dosing guidelines.
## Contraindications
* Known severe hypersensitivity (e.g., anaphylaxis) to cefixime or other cephalosporins.
* History of severe allergic reactions (e.g., anaphylaxis, Stevens-Johnson syndrome) to penicillins or other beta-lactams (cross-reactivity is low but possible).
## Adverse Effects
* **Common:** Diarrhea (most frequent), abdominal pain, nausea, dyspepsia, rash.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity reactions, seizures (rare, primarily in renal failure).
## Key Drug Interactions
* **Anticoagulants:** May increase the anticoagulant effect of Warfarin (monitor INR).
* **Probenecid:** Inhibits renal excretion of cefixime, significantly increasing serum levels; use with caution.
* **Live Vaccines:** Antibiotics may diminish the therapeutic effect of the typhoid vaccine.
## Monitoring
* Monitor for signs of hypersensitivity reactions during the first dose.
* Observe for persistent or severe diarrhea (signs of CDAD).
* Renal function (CrCl) baseline and periodically in patients with chronic kidney disease.
## Clinical Pearls
* Cefixime is not active against Staphylococci (*S. aureus*) or *Pseudomonas aeruginosa*.
* The suspension form is often preferred for pediatric dosing accuracy; ensure dosing is calculated by weight.
* Food intake does not significantly affect the rate or extent of oral absorption.
* For suspected gonorrhea, verify local resistance patterns, as cefixime is often used in combination with other agents due to rising resistance.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and local susceptibility patterns vary. Always verify current prescribing information, dosing, and contraindications using institutional formulary resources or authoritative databases (e.g., Lexicomp, UpToDate) before prescribing or administering medication.
