Objective: To evaluate the causality of peripheral cyanosis in a patient on cefixime. Methods: An 8 month old male infant presented with vomiting, diarrhea & fever for the past two days to the outpatient department of pediatrics. He was diagnosed with acute gastroenteritis and was started with syrup cefixime, syrup bifilac, syrup zinconia and syrup domperidone. The infant developed peripheral cyanosis after an hour of starting the treatment. The patient was given hydrocortisone 80 mg, avil 4 mg intravenously immediately and his condition improved and recovered within next 20 minutes. Syrup cefixime was stopped and discontinued. Adverse drug reaction monitoring centre was notified about the reaction and suspected adverse drug reaction reporting form version 1.2 was used to fill in the details. The causality assessment was done by who–umc causality scale (4) Results: The causality of cefixime was found to be ‘probable’ and for other concomitant drugs it was ‘possible’ by the who–umc causality scale. The causal relationships of other drugs with the reaction were evaluated and found to be ‘possible’. Conclusion: Cefixime was found to have ‘probable’ causality in this case of peripheral cyanosis.