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 daily, rounded to 600 mg per day (the maximum daily dose). 1
Dosing Options
The FDA-approved cefdinir dosing for otitis media offers two administration options:
- Once-daily dosing: 600 mg once daily for 10 days
- Twice-daily dosing: 300 mg twice daily (every 12 hours) for 5-10 days
Administration Details
- Cefdinir can be administered without regard to meals
- Available as oral suspension (125 mg/5 mL or 250 mg/5 mL)
- For a 42 kg child, use the maximum daily dose of 600 mg 1
Evidence-Based Rationale
The American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) guidelines identify cefdinir as an appropriate alternative treatment for otitis media in children with non-type I hypersensitivity to penicillin 2. The 2013 AAP guidelines specifically list cefdinir (14 mg/kg/day in 1 or 2 doses) as an alternative treatment option 2.
Efficacy Considerations
When choosing between once-daily and twice-daily dosing, consider:
Duration: The FDA label indicates 5-10 days of treatment is appropriate 1
Comparative efficacy: A head-to-head study showed that high-dose amoxicillin/clavulanate had better cure rates (86.5%) than cefdinir (71.0%) for acute otitis media 3, suggesting cefdinir may be less effective than first-line therapy
Pathogen coverage: Cefdinir shows good activity against common otitis media pathogens including Haemophilus influenzae and Moraxella catarrhalis, but has reduced efficacy against penicillin-resistant Streptococcus pneumoniae 4
Important Clinical Considerations
First-line therapy: Amoxicillin remains the first-line treatment for most cases of otitis media 2
When to use cefdinir: Consider cefdinir when:
- Patient has non-type I hypersensitivity to penicillin
- Previous treatment failure with amoxicillin
- Concurrent conjunctivitis (suggesting H. influenzae infection) 2
Monitoring: Assess response within 48-72 hours; if symptoms persist or worsen, reevaluation is necessary 2
Common side effects: Diarrhea is the most frequent adverse event, though generally less common than with amoxicillin/clavulanate 5
Practical Administration
For a 42 kg child using the 250 mg/5 mL suspension:
- Once-daily dosing: 12 mL once daily for 10 days
- Twice-daily dosing: 6 mL twice daily for 5-10 days
Remember that the suspension should be shaken well before each administration and can be stored at room temperature for up to 10 days after reconstitution 1.