Cefixime Trihydrate is an oral third generation cephalosporin antibiotic. Chemically, it is (6R,7R)-7- {[2-(2-amino-1,3- thiazol-4-yl)-2-(carboxymethoxyimino) acetyl]amino}-3- ethenyl-8-oxo- 5-thia-1-azabicyclo-[4.2.0]oct-2-ene-2- carboxylic acid, clinically used in the treatment of susceptibleinfections including gonorrhoea, otitis media, pharyngitis, lower respiratory-tract infectionssuch as bronchitis, and urinary-tract infections.
Dicloxacillin {ER} is a narrow-spectrum beta-lactam antibiotic of the penicillin class. It is used totreat infections caused by susceptible Gram-positive bacteria. It is active against beta- lactamase-producing organisms such as Staphylococcus aureus, which would otherwise beresistant to most penicillins.

Indications:
● Otitis Media caused by Haemophilus influenzae( beta- lactamase +ve & -ve strains), Moraxella catarrhal is (most of which are beta- lactamase +ve) and Streptococcus pyogenes.
● Pharyngitis and Tonsillits caused by Streptococcus pyogenes.
● Acute Bronchitis and Acute Exacerbations of Chronic Bronchitis caused by Streptococcus pneumoniae and Haemophilus influenzae( beta - lactamase +ve & -ve strains).
● Beta Lactamase producing pathogens- In the treatment of infections with Staphylococcus aureus and Bacteroides fragilis or with beta-lactamase producing H.influenzae and E.coli.
● Abcess(pus formation).
● Injuries.
● Osteomylitis.
● Skin and soft tissue infections.
● Ensures complete bacterial death.

Rationale of Combination:
● Reduction in the frequency of the dosing.
● Increase in the effectiveness of drug by localization at the site of action.
● Uniform drug delivery.
● Release of one or more drugs continuously in a predetermined pattern for a fixed period time, either systemically or to a specified target organ.

Pharmacology:

Cefixime Trihydrate:
Absorption: About 40% to 50% is absorbed. C maxfollowing 200 and 400 mg doses of oral suspension are 3 and 4.6 mcg/mL, respectively. T max occurs between 2 and 6 h following administration of 400 mg and between 2 and 5 h after a 200 mg dose.
Distribution: Protein binding is about 65%.
Elimination: About 50% of absorbed dose is excreted unchanged in the urine in 24 h. Serum t ┬Żaverages 3 to 4 h, but may be as long as 9 h in some healthy subjects.

Dicloxacillin:
Absorption: Absorption of the isoxazolyl penicillins after oral administration is rapid but incomplete: peak blood levels are achieved in 1-1.5 hours. Oral absorption of dicloxacillin is delayed when the drugs are administered after meals.
Protein binding: Binds to serum protein, mainly albumin.
Elimination: Dicloxacillin sodium is rapidly excreted as unchanged drug in the urine by glomerular filtration and active tubular secretion.
Half life: The elimination half-life for dicloxacillin is about 0.7 hour.

Adverse Effects:
● Stomach upset/pain
● Diarrhea
● Nausea
● Gas
● Headache or dizziness.

Contraindications:
This tablet is contraindicated In patients with known hypersensitivity to the cephalosporin or penicillin antibiotics. It is also contraindicated in patients with a history of kidney disease.

Drug Interactions:
Elevated carbamazepine levels have been reported when tablet is administrated concomitantly with carbamazepine salt and with warfarin and anticoagulantsdrugs, the prothrombin time is increased when this tablet is administrated concomitantly due to cefixime interaction.
Probenecid slows down the removal of dicloxacillin from your body, resulting in higher levels of this antibiotic in your bloodstream.
Although most antibiotics probably do not affect hormonal birth control such as pills, patch, or ring, some antibiotics may decrease their effectiveness. This could cause pregnancy. Examples include rifamycins such as rifampin or rifabutin. Be sure to ask your doctor or pharmacist if you should use additional reliable birth control methods while using this antibiotic.
Dicloxacillin may cause false positive results with certain diabetic urine testing products (cupric sulfate-type). This drug may also affect the results of certain lab tests. Make sure laboratory personnel and your doctors know you use this drug.

Precautions:
● Medical history, especially of: kidney disease.
● This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.
● Dicloxacillin passes into breast milk. Consult your doctor before breast-feeding.