Is it appropriate to prescribe cefdinir to an 8-year-old patient with a history of otitis media (inflammation of the middle ear) one month ago, who was previously treated with amoxicillin (amoxicillin) but did not complete the course?

From the Guidelines

Cefdinir is an appropriate choice for an 8-year-old with recurrent or persistent otitis media who previously took amoxicillin but didn't complete the course, as recommended by the American Academy of Pediatrics in 2013 1. The typical dosage for children is 14 mg/kg/day divided into one or two doses (maximum 600 mg daily) for 5-10 days. Since the previous amoxicillin treatment was incomplete, using a different antibiotic like cefdinir is reasonable to address possible resistant bacteria. Cefdinir is a third-generation cephalosporin that provides broader coverage against common ear infection pathogens, including beta-lactamase producing organisms that might have survived the incomplete amoxicillin course. Some key points to consider when prescribing cefdinir include:

• The patient's history of otitis media and previous treatment with amoxicillin
• The potential for resistant bacteria due to the incomplete course of amoxicillin
• The importance of completing the full prescribed course of cefdinir to ensure complete eradication of the infection
• Common side effects of cefdinir, such as diarrhea and rash
• The need for reevaluation if symptoms don't improve within 48-72 hours of starting cefdinir It's also important to note that, according to the study 1, cefdinir is highly unlikely to be associated with cross-reactivity with penicillin allergy, making it a suitable option for patients who have previously taken amoxicillin. Additionally, emphasize to the caregivers the importance of completing the full antibiotic course even if symptoms improve quickly. The American Academy of Pediatrics recommends cefdinir as an alternative treatment for patients who have taken amoxicillin in the previous 30 days 1. Overall, cefdinir is a reasonable choice for this patient, and its use is supported by the latest clinical guidelines 1.

From the FDA Drug Label

Patients should be counseled that antibacterial drugs including cefdinir should only be used to treat bacterial infections. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by cefdinir or other antibacterial drugs in the future.

It is not appropriate to prescribe cefdinir to an 8-year-old patient with a history of otitis media one month ago, who was previously treated with amoxicillin but did not complete the course, without confirming a new bacterial infection. The patient should be evaluated for a current bacterial infection before prescribing cefdinir 2, 2.

From the Research

Patient History and Current Condition

• The patient is an 8-year-old with a history of otitis media (inflammation of the middle ear) one month ago.
• The patient was previously treated with amoxicillin but did not complete the course.

Treatment Options for Otitis Media

• According to 3, high-dose amoxicillin remains the drug of choice for treatment of acute otitis media, but for persistent or recurrent cases, cefdinir is a recommended alternative.
• 4 compared the efficacy of cefdinir with amoxicillin/clavulanate in treating suppurative acute otitis media in children and found that cefdinir was as effective as amoxicillin/clavulanate.
• 5 found that first-line antibiotics (such as amoxicillin) were just as effective as broader-spectrum, second-line antibiotics (such as cefdinir) in treating recurrent otitis media.

Cefdinir as a Treatment Option

• 4 suggests that cefdinir may be a better alternative than amoxicillin/clavulanate for refractory acute otitis media, with fewer gastrointestinal adverse reactions.
• 6 compared 5-day cefdinir treatment with 10-day low-dose amoxicillin/clavulanate treatment for acute otitis media and found that cefdinir was comparable in efficacy, with a lower incidence of drug-related adverse events.

Considerations for Prescribing Cefdinir

• The patient's history of not completing the previous amoxicillin course may affect the choice of treatment, but 5 suggests that first-line antibiotics can still be effective in such cases.
• The patient's age and previous treatment with amoxicillin should be taken into account when deciding on a treatment plan, as suggested by 7.