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# Tabgenixim: Cefixime
## Overview
Cefixime is a third-generation cephalosporin antibiotic with broad-spectrum activity against many Gram-positive and Gram-negative bacteria. It is administered orally.
## Primary Indications
* **Uncomplicated urinary tract infections (UTIs):** Caused by susceptible organisms (e.g., *Escherichia coli*, *Proteus mirabilis*, *Klebsiella pneumoniae*, *Streptococcus agalactiae*).
* **Otitis media (ear infections):** In children caused by susceptible organisms.
* **Pharyngitis/Tonsillitis:** Caused by *Streptococcus pyogenes*.
* **Acute exacerbations of chronic bronchitis (AECB):** Caused by susceptible organisms.
* **Uncomplicated gonorrhea:** Caused by *Neisseria gonorrhoeae*.
## Adult Dosing
* **UTIs, AECB, Pharyngitis:** 400 mg once daily or 200 mg every 12 hours.
* **Gonorrhea:** 400 mg as a single dose.
## Pediatric Dosing
* Dosing is typically based on weight (e.g., 8 mg/kg once daily or 4 mg/kg every 12 hours).
* **Maximum daily dose:** 400 mg.
* Specific pediatric dosing for otitis media, UTIs, and other infections may vary based on age, weight, and severity of infection. Consult specific pediatric guidelines.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is recommended for patients with significant renal impairment.
* Creatinine clearance (CrCl) 30-60 mL/min: 400 mg once daily or 200 mg every 12 hours.
* CrCl 11-29 mL/min: 200 mg once daily.
* CrCl <10 mL/min (and not on hemodialysis): 200 mg every other day.
* Patients on hemodialysis: Dose guidance may vary; consult specific guidelines.
## Contraindications
* Known hypersensitivity to cefixime, other cephalosporins, or any component of the formulation.
* History of immediate or severe allergic reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, abdominal pain, headache, rash, pruritus.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, seizures, hepatic dysfunction, renal dysfunction.
## Key Drug Interactions
* **Warfarin:** May increase the anticoagulant effect of warfarin; monitor INR closely.
* **Aminoglycosides, loop diuretics:** Increased risk of nephrotoxicity.
* **Probenecid:** May increase cefixime plasma concentrations.
* **Carbamazepine:** Cefixime may increase carbamazepine levels.
## Monitoring
* **Culture and sensitivity tests:** Before initiation of treatment to ensure bacterial susceptibility.
* **Renal function:** Especially in patients with pre-existing renal impairment or those receiving concomitant nephrotoxic agents.
* **Stool:** Monitor for signs of *C. difficile* infection (persistent diarrhea).
* **Allergic reactions:** Monitor for signs of hypersensitivity.
* **INR:** If patient is on warfarin concurrently.
## Clinical Pearls
* Cefixime is effective against many Gram-negative organisms, including *Haemophilus influenzae*, *Moraxella catarrhalis*, and *Neisseria gonorrhoeae*.
* Its activity against Gram-positive organisms is less potent than some other cephalosporins.
* Ensure adequate hydration to prevent dehydration from diarrhea, nausea, or vomiting.
* Discontinue cefixime and initiate appropriate treatment if a severe hypersensitivity reaction or CDAD occurs.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines for complete details, including dosage adjustments, contraindications, drug interactions, and specific indications, as this summary may not be exhaustive and local protocols may apply.
