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# Cefixime (Genixim)
## Overview
Cefixime is a third-generation cephalosporin antibiotic. It possesses broad-spectrum activity against Gram-negative organisms and stable activity against many beta-lactamases, though it has limited efficacy against *Staphylococcus aureus* or *Pseudomonas aeruginosa*.
## Primary Indications
* Acute otitis media (AOM)
* Pharyngitis and tonsillitis
* Acute exacerbation of chronic bronchitis
* Uncomplicated urinary tract infections (UTIs)
* Uncomplicated gonorrhea (cervical, urethral, rectal)
## Adult Dosing
* **Respiratory/UTI/General Infections:** 400 mg daily or 200 mg PO q12h.
* **Uncomplicated Gonorrhea:** 800 mg orally as a single dose (refer to current CDC guidelines as this may require combination therapy).
* **Max Dose:** 400 mg/day for standard infections; 800 mg single dose for gonorrhea.
## Pediatric Dosing
* **General Inf.:** 8 mg/kg/day PO divided q12h or as a single daily dose.
* **Max Dose:** Do not exceed 400 mg/day.
* **Note:** Safety in infants < 6 months is not established.
## Dose Adjustments
* **Renal Impairment:** If CrCl 21–60 mL/min, decrease dose by 25%. If CrCl < 20 mL/min, administer 50% of the standard dose.
* **Hepatic Impairment:** No specific guidelines; caution is advised.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of severe allergic reaction (e.g., anaphylaxis) to penicillins or other beta-lactams due to potential cross-reactivity.
## Adverse Effects
* **Common:** Diarrhea (most 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
* **Anticoagulants:** May increase the anticoagulant effect of warfarin (vitamin K synthesis inhibition).
* **Probenecid:** Increases serum concentrations and toxicity risk of cefixime by decreasing renal excretion.
## Monitoring
* Monitor for signs of superinfection/anaphylaxis during initial doses.
* Monitor renal function in patients with pre-existing impairment.
* Observe for persistent watery/bloody diarrhea (potential *C. diff*).
## Clinical Pearls
* The suspension and tablet formulations have different bioavailability profiles and are not strictly bioequivalent on a mg-per-mg basis; individual manufacturer instructions should be followed.
* Cefixime has poor activity against *Staphylococcus aureus* and is not an appropriate treatment for skin/soft tissue infections suspected of being staphylococcal.
* Take with or without food; the suspension does not require refrigeration.
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**Disclaimer:** This information is for educational purposes only. Clinical protocols and resistance patterns vary by region. Always verify dosing and indications against the most current institutional guidelines, local antibiograms, and the official FDA-approved product labeling before prescribing.
