From the Guidelines
For a 3-year-old child with acute otitis media (AOM), the recommended dosing schedule for cefdinir is 14 mg/kg/day, divided into one or two doses, as stated in the guidelines from the American Academy of Pediatrics 1. This typically translates to 7 mg/kg twice daily, but can also be given as a single daily dose. For most 3-year-olds weighing between 14-18 kg, this would mean a dose of 100-125 mg twice daily, or 200-250 mg once daily. The exact dose should be calculated based on the child's precise weight. Cefdinir is available as a suspension (250 mg/5 mL) or capsules (300 mg). For young children, the suspension is usually preferred. Shake the bottle well before each use and use a proper measuring device for accurate dosing. This antibiotic should be given with or without food, but avoid giving it with iron-fortified infant formulas as this can reduce absorption. Complete the full course of antibiotics even if symptoms improve before finishing the medication. Some key points to consider when prescribing cefdinir for AOM include:
- Cefdinir is effective against common bacteria causing AOM, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- It's a third-generation cephalosporin, which provides broader coverage than some first-line antibiotics, making it suitable for cases where initial treatment has failed or in areas with high antibiotic resistance.
- The choice of cefdinir should be based on the anticipated clinical response and the microbiologic flora likely to be present, as well as the patient's allergy history, as noted in the guidelines from the American Academy of Family Physicians 1.
From the FDA Drug Label
The recommended dosage and duration of treatment for infections in pediatric patients are described in the following chart; the total daily dose for all infections is 14 mg/kg, up to a maximum dose of 600 mg per day. Acute Bacterial Otitis Media 7 mg/kg q12h or 14 mg/kg q24h 5 to 10 days 10 days
For a 3-year-old with Acute Otitis Media, the recommended dosage is:
- 7 mg/kg every 12 hours or
- 14 mg/kg every 24 hours The duration of treatment is 5 to 10 days for the 7 mg/kg q12h dose, or 10 days for the 14 mg/kg q24h dose 2.
From the Research
Cefdinir Dosing Schedule for Acute Otitis Media
- The recommended dosing schedule for cefdinir in the treatment of acute otitis media (AOM) is 14 mg/kg once daily or 7 mg/kg twice daily for 10 days 3.
- A study comparing the safety and efficacy of cefdinir vs amoxicillin/clavulanate for the treatment of suppurative AOM in children found that a 10-day regimen of cefdinir 14 mg/kg once daily was as clinically effective as a 10-day regimen of amoxicillin/clavulanate 40/10 mg/kg/day divided three times a day 3.
- Another study investigated the use of high-dose cefdinir (25 mg/kg once daily) in children with AOM at high risk of persistent or recurrent infection, and found that this regimen resulted in an overall successful clinical response at the end of treatment of 83% 4.
- However, it's worth noting that the effectiveness of cefdinir against penicillin-nonsusceptible S. pneumoniae strains was decreased, with eradication rates of 43% compared to 91% for penicillin-susceptible strains 4.
Considerations for a 3-Year-Old Patient
- For a 3-year-old patient with AOM, the recommended dosing schedule would be 14 mg/kg once daily or 7 mg/kg twice daily for 10 days, depending on the severity of the infection and the presence of any underlying conditions 3.
- It's also important to consider the potential for gastrointestinal adverse reactions, such as diarrhea, which were more common in patients treated with amoxicillin/clavulanate than with cefdinir 3.
Alternative Treatment Options
- If the patient has a history of penicillin allergy, cefdinir or azithromycin may be considered as alternative treatment options 5.
- However, the choice of antibiotic should be guided by the severity of the infection, the presence of any underlying conditions, and the potential for resistance to certain antibiotics 6, 5.