Cefdinir Dosing for Otitis Media in a 42 kg Child
For a 42 kg child with otitis media, the recommended dose of cefdinir is 14 mg/kg/day, which equals 588 mg per day, rounded to 600 mg daily (the maximum daily dose). 1
Dosing Options
Cefdinir can be administered in two different regimens for otitis media:
- Once-daily dosing: 600 mg once daily for 10 days
- Twice-daily dosing: 300 mg twice daily for 5-10 days
According to the FDA label, both dosing regimens are effective for otitis media, though once-daily dosing has been studied specifically for a 10-day duration 1.
Administration Details
- Cefdinir can be administered without regard to meals
- For a 42 kg child using the 250 mg/5 mL suspension:
- Once-daily regimen: 12 mL once daily
- Twice-daily regimen: 6 mL twice daily
Evidence Supporting This Recommendation
The American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) guidelines identify cefdinir as an appropriate alternative treatment for otitis media when amoxicillin cannot be used, particularly in cases of non-type I hypersensitivity reactions to penicillin 2.
The 2013 AAP guidelines specifically list cefdinir at a dose of 14 mg/kg/day in 1 or 2 doses as an appropriate alternative treatment 2. This is consistent with the FDA-approved dosing in the drug label 1.
Clinical Considerations
Efficacy Considerations
While cefdinir is an appropriate option, it's worth noting that:
- High-dose amoxicillin (80-90 mg/kg/day) remains the first-line treatment for otitis media when there are no contraindications 2
- In comparative studies, amoxicillin/clavulanate demonstrated better cure rates (86.5%) than cefdinir (71.0%) for acute otitis media 3
- Cefdinir's efficacy against penicillin-resistant S. pneumoniae is limited, with eradication rates of only 43% for penicillin-resistant strains 4
Safety Profile
Cefdinir is generally well-tolerated with diarrhea being the most common adverse effect, though at a lower rate than with amoxicillin/clavulanate 5. This favorable gastrointestinal profile may be advantageous for some patients.
Duration of Therapy
For otitis media, the recommended duration is 5-10 days 1. The appropriate duration depends on:
- Patient age (longer duration for younger children)
- Severity of symptoms
- Response to therapy
Important Caveats
Higher doses of cefdinir (25 mg/kg/day) have been studied but showed increased diarrhea (20% of subjects) without sufficient efficacy against resistant pneumococci 6
Cross-reactivity between penicillins and cefdinir is minimal due to its chemical structure, making it suitable for patients with non-severe penicillin allergies 2
For patients with creatinine clearance <30 mL/min/1.73 m², the dose should be reduced to 7 mg/kg once daily 1
In summary, for a 42 kg child with otitis media, cefdinir at 600 mg daily (either as 600 mg once daily or 300 mg twice daily) is the appropriate dose, with consideration of the patient's allergy status, local resistance patterns, and clinical presentation.