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# Cefixime (Tabgenixim)
## Overview
Cefixime is a third-generation oral cephalosporin. It functions by inhibiting bacterial cell wall synthesis through binding to penicillin-binding proteins (PBPs). It possesses broad-spectrum activity against many Gram-negative bacteria but has limited activity against Gram-positive organisms (e.g., *Staphylococcus aureus*).
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Uncomplicated gonorrhea (cervical, urethral, and rectal)
* Acute exacerbations of chronic bronchitis
## Adult Dosing
* **General infections:** 400 mg daily, given as a single dose or in two divided doses (200 mg every 12 hours).
* **Uncomplicated gonorrhea:** 800 mg orally as a single dose.
## Pediatric Dosing
* **Weight < 50 kg:** 8 mg/kg/day, administered as a single daily dose or in two divided doses (4 mg/kg every 12 hours).
* **Weight ≥ 50 kg or age > 12 years:** Use adult dosing (400 mg daily).
## 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.
* **Hepatic Impairment:** No specific adjustment necessary.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporin antibiotics.
* History of severe, immediate hypersensitivity reactions (e.g., anaphylaxis) to penicillins or other beta-lactams (cross-reactivity risk).
## Adverse Effects
* **Common:** Diarrhea (very common), nausea, abdominal pain, 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.
* **Probenecid:** May increase serum concentrations of cefixime by reducing renal excretion.
* **Live Vaccines (e.g., BCG, Typhoid):** Antibiotics may decrease the efficacy of live vaccines.
## Monitoring
* Monitor for signs of anaphylaxis during the first dose.
* Monitor resolution of infection symptoms.
* Assess for persistent diarrhea (potential *C. difficile* infection).
* In prolonged therapy: Monitor renal and hepatic function, and CBC.
## Clinical Pearls
* Cefixime has poor activity against *Staphylococcus* species and should not be used for skin and soft tissue infections unless susceptibility is confirmed.
* Unlike many other oral cephalosporins, cefixime is chemically stable in the presence of various beta-lactamases produced by Gram-negative organisms.
* The suspension (if available) may be easier to dose for pediatric patients; always verify the concentration of the oral suspension provided by the pharmacy.
* Ensure the patient is counseled to finish the full course of therapy even if symptoms resolve.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Dosing can vary based on local susceptibility patterns, hospital protocols, and specific patient comorbidities. Always verify the most current prescribing information, package inserts, and institutional guidelines before prescribing or administering medication.
