Is cefdinir (Cefdinir) effective for treating otitis media (middle ear infection)?

From the Guidelines

Cefdinir is a suitable alternative treatment for otitis media, particularly in patients with penicillin allergy, with a recommended dosage of 14 mg/kg/day in children and 300 mg twice daily in adults. When considering the treatment of otitis media, it is essential to prioritize the most effective and safe antibiotic options. According to the American Academy of Pediatrics guidelines 1, high-dose amoxicillin is the first-line treatment for most patients, but cefdinir is an alternative option for patients with penicillin allergy. The guidelines suggest that cefdinir, cefuroxime, cefpodoxime, and ceftriaxone are highly unlikely to be associated with cross-reactivity with penicillin allergy due to their distinct chemical structures.

Key Considerations for Cefdinir Use

• Cefdinir is effective against common otitis media pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
• The recommended dosage for children is 14 mg/kg/day divided into one or two doses for 5-10 days, with a maximum of 600 mg daily.
• For adults, the standard dose is 300 mg twice daily for 5-10 days.
• Cefdinir should be taken with food to improve absorption, and patients should complete the full course even if symptoms improve before finishing.
• Iron supplements and antacids containing aluminum or magnesium should be taken at least 2 hours before or after cefdinir to avoid reduced absorption.

Comparison with Other Antibiotics

• A study published in Otolaryngology--head and neck surgery 1 ranked cefdinir as one of the effective antibiotic options for acute bacterial rhinosinusitis, with a predicted clinical efficacy of 83-88%.
• The study also noted that cefdinir is a suitable alternative for patients with penicillin allergy, with a low risk of cross-reactivity.

Patient Safety and Efficacy

• Cefdinir has been shown to be effective in eradicating common otitis media pathogens, with a eradication rate of 72% in patients with recurrent AOM attributable to H. influenzae 1.
• The medication is generally well-tolerated, with common side effects including diarrhea, nausea, and rash.
• Patients with severe infections or immunocompromised patients may require longer treatment courses.

From the FDA Drug Label

Pediatric Patients Acute Bacterial Otitis Media caused by Haemophilus influenzae (including β-lactamase producing strains), Streptococcus pneumoniae (penicillin-susceptible strains only), and Moraxella catarrhalis (including β-lactamase producing strains).

Cefdinir is indicated for the treatment of Acute Bacterial Otitis Media in pediatric patients caused by susceptible strains of Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis 2.

• The drug is effective against β-lactamase producing strains of Haemophilus influenzae and Moraxella catarrhalis.
• Streptococcus pneumoniae strains must be penicillin-susceptible for cefdinir to be effective. Middle ear fluid concentrations of cefdinir were studied in 14 pediatric patients with acute bacterial otitis media, with median concentrations of 0.21 and 0.72 mcg/mL after single 7 and 14 mg/kg doses, respectively 2.

From the Research

Cefdinir for Otitis Media

• Cefdinir is an oral third-generation cephalosporin with good in vitro activity against many pathogens commonly causative in community-acquired infections, including those that cause otitis media 3.
• The drug provides good coverage against Haemophilus influenzae, Moraxella catarrhalis, and penicillin-susceptible Streptococcus pneumoniae, which are common respiratory tract pathogens 3.
• Cefdinir has been shown to be effective in the treatment of acute otitis media (AOM) in children, with clinical cure rates comparable to those of amoxicillin/clavulanate and cefprozil 4, 5.
• A 5-day course of cefdinir has been found to be as effective as a 10-day course of cefprozil in the treatment of nonrefractory AOM 5.
• Cefdinir has also been shown to be effective in the eradication of common causative pathogens of nonrefractory AOM, including intermediate penicillin-resistant S. pneumoniae and beta-lactamase-producing organisms 6.
• However, one study found that high-dose amoxicillin/clavulanic acid was more effective than cefdinir in the treatment of AOM in children, particularly in older children 7.

Dosage and Administration

• Cefdinir can be administered once or twice daily, depending on the dosage regimen 3.
• The recommended dosage of cefdinir for the treatment of AOM in children is 14 mg/kg/day divided twice a day for 5 or 10 days 4, 5.
• A 5-day course of cefdinir has been found to be as effective as a 10-day course of cefprozil in the treatment of nonrefractory AOM 5.

Adverse Reactions

• Diarrhea is the most common adverse reaction associated with cefdinir, occurring in up to 16% of patients 4, 6.
• Other adverse reactions, such as overall adverse reactions, occur in up to 13% of patients 5.