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# Tegenixim (Cefixime)
## Overview
Cefixime is a third-generation, broad-spectrum cephalosporin antibiotic. It acts by inhibiting bacterial cell wall synthesis. Unlike some other cephalosporins, it possesses enhanced activity against Gram-negative organisms but limited activity against *Staphylococcus aureus*.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Gonococcal infections (uncomplicated)
* Acute bronchitis and acute exacerbations of chronic bronchitis
## Adult Dosing
* **General infections:** 400 mg daily, administered either as a single dose or divided 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** 400 mg as a single oral dose.
* **Maximum Dose:** 400 mg per day.
## Pediatric Dosing
* **General infections (Children > 6 months):** 8 mg/kg/day, administered once daily or in two divided doses (4 mg/kg every 12 hours).
* **Otitis Media:** 8 mg/kg/day once daily or divided every 12 hours.
* **Maximum Dose:** Do not exceed 400 mg per day. Safety and efficacy in infants < 6 months have not been established.
## Dose Adjustments
* **Renal Impairment:**
* Creatinine Clearance (CrCl) 21–60 mL/min: Reduce dose by 25% (or 300 mg daily).
* CrCl < 20 mL/min: Reduce dose by 50% (or 200 mg daily).
* **Hepatic Impairment:** No specific adjustment guidelines exist; use with caution.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of severe, immediate hypersensitivity reactions (e.g., anaphylaxis) to penicillins or other beta-lactams.
## Adverse Effects
* **Common:** Diarrhea (often dose-dependent), abdominal pain, nausea, and dyspepsia.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (rash, urticaria, Stevens-Johnson syndrome), and seizures (in cases of significant overdose/renal failure).
## Key Drug Interactions
* **Warfarin:** May increase International Normalized Ratio (INR) and bleeding risk by altering gut flora; monitor INR closely.
* **Carbamazepine:** Cefixime may increase serum concentrations of carbamazepine.
* **Probenecid:** May increase serum levels of cefixime by inhibiting renal tubular secretion.
## Monitoring
* **Renal Function:** Monitor periodically, especially in elderly or patients with pre-existing renal impairment.
* **Clinical Efficacy:** Monitor for resolution of symptoms.
* **Safety:** Monitor for signs of *C. difficile* (persistent diarrhea) or allergic skin reactions.
## Clinical Pearls
* **Administration:** May be taken with or without food. Oral suspension should be shaken well.
* **Spectrum:** Not effective against *Pseudomonas aeruginosa* or MRSA.
* **GI Sensitivity:** To minimize diarrhea, consider dividing the daily dose into two 200 mg doses rather than one 400 mg dose.
* **Local Protocol:** Always check local antibiograms; resistance patterns for *Neisseria gonorrhoeae* are geographically variable and may necessitate combination therapy per CDC guidelines.
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*Disclaimer: This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and patient-specific factors via official drug monographs (e.g., Lexicomp, Micromedex) before prescribing or administering medication.*
