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# Cefixime
## Overview
Cefixime is a third-generation cephalosporin antibiotic. It exhibits broad-spectrum activity against Gram-negative organisms and limited activity against Gram-positive organisms (e.g., *Streptococcus pneumoniae*). It is administered orally.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Acute exacerbations of chronic bronchitis
* Uncomplicated gonorrhea (cervical, urethral, or rectal)
## Adult Dosing
* **General infections:** 400 mg daily, administered either as a single dose or divided into 200 mg every 12 hours.
* **Uncomplicated gonorrhea:** 800 mg orally as a single dose (note: verify current national guidelines as dual therapy or alternative agents may be required).
## Pediatric Dosing
* **Children (>6 months):** 8 mg/kg/day orally, administered as a single daily dose or in two divided doses (4 mg/kg every 12 hours).
* **Maximum:** 400 mg/day.
## Dose Adjustments
* **Renal Impairment:**
* CrCl 21–60 mL/min: Administer 75% of the standard dose.
* CrCl <20 mL/min: Administer 50% of the standard dose.
* Hemodialysis: No supplemental dose required; remain at 50% dose.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins (consider cross-reactivity in patients with severe penicillin allergy).
## Adverse Effects
* **Common:** Diarrhea (often dose-dependent), abdominal pain, nausea, dyspepsia, and flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (anaphylaxis, rash, urticaria), and rarely, Stevens-Johnson syndrome or toxic epidermal necrolysis.
## Key Drug Interactions
* **Warfarin:** May enhance the anticoagulant effect by altering gut flora (vitamin K synthesis). Monitor INR.
* **Probenecid:** May increase serum levels of cefixime by inhibiting renal excretion.
## Monitoring
* Monitor for signs of hypersensitivity, including rash or anaphylaxis.
* Monitor stool frequency and consistency if diarrhea develops (evaluate for *C. difficile* if severe).
* In prolonged therapy, monitor renal and hematologic function.
## Clinical Pearls
* **Bioavailability:** Cefixime oral suspension has higher bioavailability compared to the tablet formulation; they are not strictly bioequivalent based on mg-to-mg dosing in some settings.
* **Spectrum:** Cefixime has poor activity against *Staphylococcus aureus* and is not indicated for infections where this organism is suspected.
* **Administration:** It can be taken with or without food.
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**Educational Disclaimer:** This information is for educational purposes only. Always verify dosages, contraindications, and drug interactions against institutional protocols and the most current manufacturer-provided prescribing information (package insert) before prescribing or administering medication.
