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# Tabgenixim (Cefixime)
## 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 (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, either as a single dose or divided into 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** 800 mg as a single oral dose (note: check local resistance patterns; current CDC guidelines favor ceftriaxone injection).
## Pediatric Dosing
* **General infections (≥6 months):** 8 mg/kg/day administered as a single daily dose or divided into 4 mg/kg every 12 hours.
* **Maximum dose:** 400 mg per day.
* *Note: Oral suspension is preferred for pediatric patients.*
## Dose Adjustments
* **Renal Impairment:** If CrCl 21–60 mL/min, reduce dose by 25%. If CrCl <20 mL/min, reduce dose by 50% (max 200 mg daily).
* **Hepatic Impairment:** No specific dosage adjustments established.
## Contraindications
* Known hypersensitivity (anaphylaxis) to cefixime or other cephalosporins.
* History of severe allergic reactions (e.g., IgE-mediated anaphylaxis) to penicillins (due to potential for cross-reactivity).
## Adverse Effects
* **Common:** Diarrhea (frequent), abdominal pain, nausea, dyspepsia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (rash, urticaria, serum sickness), and rare cases of Stevens-Johnson syndrome.
## Key Drug Interactions
* **Warfarin:** May increase INR and bleeding risk by altering gut flora (vitamin K synthesis). Monitor INR closely.
* **Carbamazepine:** Cefixime can increase serum concentrations of carbamazepine; monitor for toxicity.
* **Probenecid:** May increase serum levels of cefixime by inhibiting renal excretion.
## Monitoring
* Monitor for signs of hypersensitivity on initial doses.
* Monitor stool frequency/consistency if diarrhea persists (evaluate for *C. difficile*).
* Assess renal function periodically in patients with pre-existing renal impairment.
## Clinical Pearls
* **Bioavailability:** Cefixime tablets and oral suspension are not strictly bioequivalent; if switching formulations, consult the product label.
* **Spectrum:** It is generally ineffective against *Staphylococcus aureus* or *Pseudomonas aeruginosa*.
* **Administration:** May be taken with or without food.
* **Local Guidelines:** Always verify local susceptibility patterns and institutional antibiograms, especially for gonorrhea treatment, as regional resistance varies significantly.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Dosing and clinical decisions should be based on current, verified prescribing information, institutional guidelines, and individual patient status. Consult a licensed clinician or the official package insert prior to prescribing.
