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# Cefixime
## Overview
Cefixime is a third-generation cephalosporin antibiotic that acts by inhibiting bacterial cell wall synthesis. It is characterized by high stability in the presence of beta-lactamases and is administered orally.
## Primary Indications
* Uncomplicated urinary tract infections (UTIs)
* Otitis media
* Pharyngitis and tonsillitis
* Acute bronchitis and acute exacerbations of chronic bronchitis
* Uncomplicated gonorrhea (cervical, urethral, and rectal)
## Adult Dosing
* **General infections:** 400 mg daily, administered as a single dose or in two divided doses of 200 mg every 12 hours.
* **Uncomplicated gonorrhea:** 800 mg as a single oral dose.
## Pediatric Dosing
* **Children (>6 months):** 8 mg/kg/day, administered as a single dose or in two divided doses of 4 mg/kg every 12 hours.
* **Weight >50 kg or >12 years:** Use adult dosing (400 mg/day).
## Dose Adjustments
* **Renal Impairment (CrCl 21–60 mL/min):** Reduce the dose to 75% of the standard amount (e.g., 300 mg daily).
* **Renal Impairment (CrCl <20 mL/min):** Reduce the dosing frequency to 50% of the standard amount (e.g., 200 mg daily).
* *Note:* Cefixime is not significantly removed by hemodialysis or peritoneal dialysis.
## Contraindications
* Known hypersensitivity to cefixime or other cephalosporin antibiotics.
* History of severe allergic reactions (e.g., anaphylaxis) to penicillins or other beta-lactams.
## Adverse Effects
* **Common:** Diarrhea (most frequent), abdominal pain, nausea, dyspepsia, and flatulence.
* **Serious:** *Clostridioides difficile*-associated diarrhea, severe cutaneous adverse reactions (SCARs like Stevens-Johnson syndrome), and hypersensitivity reactions.
## Key Drug Interactions
* **Warfarin/Anticoagulants:** May enhance the anticoagulant effect by altering gut flora (vitamin K synthesis). Monitor INR.
* **Probenecid:** Can increase serum concentrations of cefixime by inhibiting renal tubular secretion.
## Monitoring
* Monitor for signs of superinfection (e.g., persistent diarrhea suggesting *C. difficile*).
* Assess renal function during prolonged therapy.
* Monitor for signs of hypersensitivity, especially in patients with a history of penicillin allergy.
## Clinical Pearls
* **Administration:** May be taken with or without food.
* **Bioavailability:** Suspension has higher bioavailability than tablets; verify formulation if switching.
* **Spectrum:** While it covers *Neisseria gonorrhoeae*, local resistance patterns must be considered; consult current CDC/local guidelines for combination therapy requirements.
* **GI Distress:** Diarrhea is common; if severe or persistent, investigate for antibiotic-associated colitis.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and local resistance patterns evolve; always verify dosing and contraindications against institutional protocols or the most recent official prescribing information (package insert) before prescribing or administering medication.
