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# Cefixime (Genixim)
## Overview
Cefixime is a third-generation cephalosporin antibiotic. It possesses broad-spectrum activity against Gram-negative organisms and moderate activity against Gram-positive organisms. It is stable against many beta-lactamases but lacks significant activity against *Staphylococcus aureus* or *Pseudomonas aeruginosa*.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Uncomplicated gonorrhea (cervical, urethral, or rectal)
* Acute exacerbations of chronic bronchitis
## Adult Dosing
* **General bacterial infections:** 400 mg daily, administered as a single dose or divided into 200 mg every 12 hours.
* **Uncomplicated gonorrhea:** 400 mg as a single oral dose.
* **Maximum dose:** 400 mg/day.
## Pediatric Dosing
* **General infections (Children >6 months / >50 kg):** 8 mg/kg/day once daily or divided into 4 mg/kg every 12 hours.
* **Otitis media:** 8 mg/kg/day once daily or 4 mg/kg twice daily.
* **Maximum dose:** 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.
* Patients on hemodialysis should not receive supplemental doses.
* **Hepatic Impairment:** No specific adjustment required.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of severe allergic reactions (e.g., anaphylaxis) to penicillins or other beta-lactams (due to potential cross-reactivity).
## Adverse Effects
* **Common:** Diarrhea (frequently dose-dependent), abdominal pain, nausea, dyspepsia.
* **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 enhance the anticoagulant effect by depleting vitamin K-producing gut flora. Monitor INR closely.
* **Probenecid:** May increase serum concentrations and the half-life of cefixime by inhibiting renal excretion.
* **Carbamazepine:** Increased serum levels have been reported with similar cephalosporins.
## Monitoring
* **Renal function:** Periodic assessment in patients with pre-existing impairment.
* **Gastrointestinal:** Monitor for persistent or severe diarrhea (signs of *C. difficile*).
* **Hypersensitivity:** Monitor for signs of rash or anaphylaxis, especially during the first dose.
## Clinical Pearls
* Cefixime is not active against *Enterococcus* species.
* The suspension form (often used in pediatrics) and tablets may not be bioequivalent; follow specific product labeling when switching formulations.
* Absorption is not significantly altered by food.
* Cefixime is a common empiric choice for *Neisseria gonorrhoeae*, but clinicians should check local antimicrobial susceptibility patterns due to emerging resistance.
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**Disclaimer:** This information is for educational purposes and does not replace professional clinical judgment. Always verify exact dosing, contraindications, and drug interactions using current, localized institutional prescribing references or the official FDA/EMA drug label before administration.
