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# Tegenixim (Cefixime)
## Overview
Tegenixim is a brand name for **Cefixime**, a third-generation cephalosporin antibiotic. It acts by inhibiting bacterial cell wall synthesis. It is notable for its stability against many beta-lactamases and its activity against Gram-negative organisms, though it has limited activity against Gram-positive bacteria (e.g., *Staphylococcus aureus*).
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Acute bronchitis or acute exacerbations of chronic bronchitis
* Uncomplicated gonorrhea (cervical, urethral, or rectal)
## Adult Dosing
* **General Infections:** 400 mg orally once daily or 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** 800 mg orally as a single dose (note: many regional guidelines, including the CDC, now recommend dual therapy with ceftriaxone injection due to resistance patterns; verify current local infectious disease protocols).
## Pediatric Dosing
* **General Infections (>6 months, >50 kg use adult dose):** 8 mg/kg/day orally as a single dose or divided into two doses (4 mg/kg every 12 hours).
* **Otitis Media:** 8 mg/kg/day once daily.
* *Note:* Safety and efficacy in infants younger than 6 months have not been established.
## Dose Adjustments
* **Renal Impairment:**
* eGFR 21–60 mL/min: Reduce dose to 75% of the standard amount.
* eGFR <20 mL/min (or hemodialysis): Reduce dose to 50% of the standard amount.
* **Hepatic Impairment:** No specific dosage adjustment required.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporins.
* History of severe allergic reactions (e.g., anaphylaxis) to penicillins or other beta-lactam antibiotics (due to potential cross-reactivity).
## Adverse Effects
* **Common:** Diarrhea (very common), abdominal pain, nausea, dyspepsia.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome), and hematologic abnormalities (thrombocytopenia, leukopenia).
## Key Drug Interactions
* **Warfarin/Anticoagulants:** May enhance the anticoagulant effect by modifying gut flora and decreasing vitamin K synthesis. Monitor INR.
* **Probenecid:** May elevate serum concentrations of cefixime by inhibiting renal excretion.
* **Carbamazepine:** Cefixime can potentially increase plasma levels of carbamazepine.
## Monitoring
* Monitor for signs of hypersensitivity (rash, pruritus).
* Evaluate patients presenting with persistent diarrhea for *C. difficile* infection.
* Assess renal function periodically in long-term therapy or in those with pre-existing renal impairment.
## Clinical Pearls
* **Food effect:** Cefixime can be taken with or without food.
* **Spectrum:** Cefixime is generally ineffective against *Staphylococcus aureus* and has variable activity against *Streptococcus pneumoniae*. It should not be used as empiric therapy for these organisms.
* **Antibiotic Stewardship:** Use only for confirmed bacterial infections to prevent resistance.
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*Disclaimer: This information is for educational purposes only. Clinical practice guidelines, regional resistance patterns, and prescribing information change frequently. Always consult the most current local clinical protocols or the official manufacturer’s prescribing information before ordering or administering medication.*
