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# Tabgenixim (Cefixime)
## Overview
Cefixime is a third-generation cephalosporin antibiotic. It is orally active, bactericidal, and stable against many beta-lactamases. It inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Acute bronchitis and acute exacerbations of chronic bronchitis
* Uncomplicated gonorrhea (cervical/urethral/rectal)
## Adult Dosing
* **Respiratory/UTI/Sinusitis:** 400 mg once daily or 200 mg every 12 hours.
* **Uncomplicated Gonorrhea:** 800 mg orally as a single dose (often combined with an anti-chlamydial agent per local guidelines).
## Pediatric Dosing
* **Standard Infections:** 8 mg/kg/day orally, administered as a single daily dose or divided into two doses (4 mg/kg every 12 hours).
* **Otitis Media:** 8 mg/kg/day once daily is often preferred for adherence.
* **Note:** Safety and efficacy in infants < 6 months have not been established.
## Dose Adjustments
* **Renal Impairment:**
* Creatinine Clearance (CrCl) 21–60 mL/min: Reduce dose by 25% (e.g., 300 mg daily).
* CrCl < 20 mL/min: Reduce dose by 50% (e.g., 200 mg daily).
* **Hepatic Impairment:** No specific adjustment necessary.
## Contraindications
* Known hypersensitivity to cefixime or any component of the cephalosporin class.
* History of severe allergic reactions (e.g., anaphylaxis) to penicillins or other beta-lactams (cross-reactivity risk).
## Adverse Effects
* **Common:** Diarrhea (frequent, dose-related), nausea, abdominal pain, dyspepsia.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (rash, urticaria, anaphylaxis), Stevens-Johnson syndrome, and hematologic abnormalities (thrombocytopenia, leukopenia).
## Key Drug Interactions
* **Anticoagulants:** May enhance the effects of warfarin; monitor INR.
* **Probenecid:** May increase serum levels of cefixime by inhibiting renal excretion.
* **Carbamazepine:** Potential for increased serum concentrations of carbamazepine.
## Monitoring
* Monitor for signs of hypersensitivity.
* Assess for resolution of infection symptoms.
* Monitor for persistent diarrhea (risk of *C. difficile*).
* In prolonged therapy, perform periodic assessment of renal and hepatic function.
## Clinical Pearls
* **Administration:** May be taken with or without food. Food may delay absorption but does not affect total bioavailability.
* **Stability:** Once reconstituted, the oral suspension should be kept at room temperature and discarded after 14 days.
* **Spectrum:** While it covers many Gram-negative organisms, it has limited activity against *Staphylococcus aureus* compared to earlier-generation cephalosporins.
* **Documentation:** Always verify local susceptibility patterns (antibiograms) before empiric use, as resistance in *Neisseria gonorrhoeae* and other pathogens is geographically variable.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Dosing and clinical practices may vary based on local protocols, patient-specific factors, and institutional policies. Always verify the most current prescribing information and institutional guidelines before prescribing or administering medication.
