Cefdinir Dosing for a 3-Year-Old with Acute Otitis Media
For a 3-year-old child with acute otitis media, the recommended dose of cefdinir is 14 mg/kg per day, given either as a single daily dose or divided into two doses (7 mg/kg twice daily) for 5-10 days. 1
Dosing Options
The FDA-approved dosing for cefdinir in pediatric patients with acute otitis media provides two administration options:
- 14 mg/kg once daily for 10 days
- 7 mg/kg twice daily for 5-10 days 1
For a typical 3-year-old weighing approximately 14-16 kg:
- Once-daily dosing: ~200-225 mg once daily
- Twice-daily dosing: ~100-112 mg twice daily
Formulation and Administration
Cefdinir is available as an oral suspension in two concentrations:
- 125 mg/5 mL
- 250 mg/5 mL 1
The medication can be administered without regard to meals, which improves compliance in young children. 1
Clinical Evidence and Guidelines
The American Academy of Pediatrics recommends cefdinir as an alternative treatment for acute otitis media in children with penicillin allergy. 2 It is particularly preferred because of high patient acceptance, likely due to its palatable taste compared to other antibiotics. 2
While high-dose amoxicillin (80-90 mg/kg/day) remains the first-line treatment for uncomplicated acute otitis media, cefdinir is an appropriate alternative when:
- The child has a penicillin allergy (non-Type I/non-anaphylactic)
- The child cannot tolerate amoxicillin
- There is concern about beta-lactamase producing organisms 2, 3
Efficacy Considerations
It's important to note that comparative studies have shown that high-dose amoxicillin/clavulanate (90 mg/kg/day of amoxicillin component) for 10 days has better clinical cure rates (86.5%) than cefdinir (71.0%) for 5 days in young children with acute otitis media. 4
Research has also shown that cefdinir's efficacy against penicillin-resistant Streptococcus pneumoniae is limited, with eradication rates of only 43% for penicillin-resistant strains compared to 91% for penicillin-susceptible strains. 5
Duration of Treatment
The FDA-approved duration for cefdinir treatment in acute otitis media is 5-10 days. 1 A 5-day course has been shown to be as effective as longer courses of other cephalosporins for uncomplicated acute otitis media. 6
Common Side Effects and Monitoring
The most common adverse effect is diarrhea, which occurs in approximately 8% of children. 6 Parents should be advised to complete the full course of antibiotics even if symptoms improve before completion.
Follow-up Recommendations
If no improvement is seen after 48-72 hours of therapy, the child should be reevaluated, and an alternative antibiotic should be considered. 2 Persistent middle ear effusion after treatment is common and does not necessarily indicate treatment failure, as 60-70% of children will have middle ear effusion at 2 weeks after successful treatment. 3