Cefixime exerts its bactericidal effect by inhibiting bacterial cell wall synthesis. According to the Lippincott Textbook of Pharmacology, cefixime binds to penicillin-binding proteins (PBPs) located on the bacterial cell wall. This binding disrupts the final stages of peptidoglycan synthesis, a critical component of the cell wall. As a result, the bacterial cell wall becomes weak and prone to rupture, leading to cell death.

The Lange Basic & Clinical Pharmacology highlights cefixime’s enhanced stability against beta-lactamases, enzymes produced by some bacteria that degrade antibiotics like penicillins and earlier-generation cephalosporins. This makes cefixime effective against many beta-lactamase-producing organisms.

Cefixime is indicated for the treatment of:

1. Respiratory Tract Infections:
   • Acute bronchitis.
   • Community-acquired pneumonia (mild to moderate).
2. Ear, Nose, and Throat (ENT) Infections:
   • Otitis media.
   • Pharyngitis and tonsillitis.
3. Urinary Tract Infections (UTIs):
   • Uncomplicated cystitis.
   • Pyelonephritis (mild to moderate).
4. Sexually Transmitted Infections (STIs):
   • Uncomplicated gonorrhea (as part of dual therapy).
5. Gastrointestinal Infections:
   • Typhoid fever (alternative to fluoroquinolones).

The BNF emphasizes that cefixime should only be used for infections caused by susceptible organisms and is ineffective against viral infections.

The dosage of cefixime varies depending on the type and severity of the infection, the patient's age, and renal function.

Adults and Children (>12 years or >50 kg):

• Most Infections: 400 mg once daily or 200 mg twice daily for 7–14 days.
• Uncomplicated Gonorrhea: A single 400 mg dose (often combined with azithromycin).

Children (<12 years or <50 kg):

• Oral Suspension: 8 mg/kg/day in 1–2 divided doses (max 400 mg/day).

Renal Impairment:

• Creatinine Clearance (CrCl) 20–60 mL/min: Reduce dose by 25%.
• CrCl <20 mL/min: Reduce dose by 50%.

Administration Tips:

• Can be taken with or without food.
• Shake the oral suspension well before use.

Cefixime is generally well-tolerated, but it may cause side effects. Common side effects, as listed in the Lippincott Textbook of Pharmacology, include:

• Gastrointestinal Issues: Diarrhea, nausea, vomiting, and abdominal pain.
• Skin Reactions: Rash, itching, and urticaria (hives).
• Central Nervous System Effects: Headache and dizziness.

Less common but serious side effects may include:

• Hypersensitivity Reactions: Anaphylaxis, angioedema, or Stevens-Johnson syndrome.
• Clostridioides difficile-Associated Diarrhea (CDAD): Due to disruption of normal gut flora.
• Hematologic Effects: Leukopenia, thrombocytopenia, or hemolytic anemia.

Patients experiencing severe side effects should seek medical attention immediately.

Before starting cefixime, certain precautions should be taken:

1. Allergy to Cephalosporins or Penicillins: Cefixime is contraindicated in patients with a history of hypersensitivity to beta-lactam antibiotics.
2. Renal Impairment: Dose adjustments are necessary for patients with reduced kidney function.
3. Pregnancy and Breastfeeding: Cefixime is generally considered safe during pregnancy and breastfeeding, but should only be used if clearly needed and under medical supervision.
4. Pediatric Use: Safe for use in children, but dosing should be based on body weight.
5. Gastrointestinal Disorders: Use with caution in patients with a history of colitis or CDAD.

Cefixime may interact with other medications, potentially altering their effects or increasing the risk of side effects. Key interactions highlighted in the BNF and Lange Basic & Clinical Pharmacology include:

• Probenecid: May increase cefixime levels by reducing its renal excretion.
• Anticoagulants (e.g., warfarin): Cefixime may enhance the anticoagulant effect, increasing the risk of bleeding.
• Oral Contraceptives: Cefixime may reduce the efficacy of hormonal contraceptives, necessitating additional contraceptive measures.
• Nephrotoxic Drugs (e.g., aminoglycosides): Increased risk of kidney damage.

Always inform your healthcare provider about all medications, supplements, and herbal products you are taking before starting cefixime.

Cefixime is the active ingredient in the brand-name medication Suprax®. In pharmacies, it may also be available under various generic names, including:

• Cefixime Trihydrate
• Cefixime Oral Suspension
• Cefixime Tablets/Capsules