What is the treatment for a bacterial upper respiratory infection (URI) in a patient allergic to penicillins, macrolides, and doxycycline (doxy), considering cefdinir?

From the Guidelines

Cefdinir is a suitable treatment option for bacterial upper respiratory infections (URI) in patients allergic to penicillins, macrolides, and doxycycline, due to its low cross-reactivity with penicillins and effectiveness against common URI pathogens. According to the American Academy of Pediatrics 1, cefdinir is highly unlikely to be associated with cross-reactivity with penicillin allergy, making it a viable alternative for patients with non-severe penicillin allergies. The recommended dosage of cefdinir is 14 mg/kg per day in 1 or 2 doses 1.

Key considerations for prescribing cefdinir in this context include:

• Assessing the nature of the penicillin allergy to determine the risk of cross-reactivity
• Monitoring for signs of allergic reaction, although the risk is low
• Ensuring the patient completes the full course of antibiotics to prevent treatment failure and resistance development
• Considering alternative options, such as fluoroquinolones or trimethoprim-sulfamethoxazole, if cefdinir is not suitable or effective

The effectiveness of cefdinir against common URI pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, makes it a reasonable choice for treating bacterial URI in patients with multiple antibiotic allergies 1. However, it is essential to weigh the benefits and risks of cefdinir treatment in each individual case, taking into account the patient's specific allergy history and medical profile.

From the FDA Drug Label

WARNINGS BEFORE THERAPY WITH CEFDINIR IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO CEFDINIR, OTHER CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS IF CEFDINIR IS TO BE GIVEN TO PENICILLIN-SENSITIVE PATIENTS, CAUTION SHOULD BE EXERCISED BECAUSE CROSS-HYPERSENSITIVITY AMONG β-LACTAM ANTIBIOTICS HAS BEEN CLEARLY DOCUMENTED AND MAY OCCUR IN UP TO 10% OF PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY.

Cefdinir use in patients allergic to penicillins, macrolides, and doxycycline:

• Cefdinir is a cephalosporin antibiotic, and there is a potential for cross-hypersensitivity with penicillins, which may occur in up to 10% of patients with a history of penicillin allergy.
• Given the patient's allergy to penicillins, macrolides, and doxycycline, caution should be exercised when considering cefdinir for treatment of a bacterial upper respiratory infection (URI).
• The patient's allergic history should be carefully evaluated, and alternative treatment options should be considered to minimize the risk of an allergic reaction.
• If cefdinir is still considered for treatment, close monitoring for signs of an allergic reaction is necessary, and emergency measures should be available in case of a serious acute hypersensitivity reaction 2.

From the Research

Treatment Options for Bacterial URI

• Cefdinir is a cephalosporin antibiotic that can be considered for the treatment of bacterial upper respiratory infections (URIs) in patients allergic to penicillins, macrolides, and doxycycline 3, 4.
• However, it is essential to note that cross-reactivity between penicillin and cephalosporins, such as cefdinir, can occur in about 2% of cases 3.
• Patients with a history of penicillin allergy should be evaluated to determine the risk of an allergic reaction to cefdinir 3, 5.

Evaluation of Penicillin Allergy

• A thorough evaluation of penicillin allergy is crucial to determine the safest treatment options for patients with a reported allergy 3, 5.
• Patients with low-risk allergy histories can undergo direct amoxicillin challenge, while those with moderate-risk histories can be evaluated with penicillin skin testing 3.
• Clinicians should consider the patient's medical history and the severity of the reported allergic reaction to determine the best course of action 4, 5.

Cefdinir Efficacy

• Cefdinir has been shown to be effective in treating urinary tract infections (UTIs), with comparable efficacy to cephalexin 6.
• However, cefdinir has lower urine penetration compared to cephalexin, which may affect its efficacy in treating UTIs 6.
• Further studies are needed to determine the efficacy of cefdinir in treating bacterial URIs in patients allergic to penicillins, macrolides, and doxycycline 6.