What is the dosage and treatment regimen for Cefdinir in bacterial infections?

Cefdinir Dosage and Treatment Regimen for Bacterial Infections

Cefdinir is an extended-spectrum oral cephalosporin with recommended dosages of 300 mg twice daily or 600 mg once daily for adults, and 14 mg/kg/day divided into one or two doses for children, with treatment duration ranging from 5-10 days depending on the specific infection. 1

Adult Dosing Regimens

Standard Adult Dosing

• Standard dose: 300 mg twice daily or 600 mg once daily 1, 2
• Duration: 5-10 days depending on infection type 2
• Renal adjustment: For adults with creatinine clearance <30 mL/min, reduce to 300 mg once daily 1
• Hemodialysis patients: 300 mg every other day with an additional 300 mg dose after each hemodialysis session 1

Infection-Specific Adult Dosing

• Acute bacterial sinusitis: 300 mg twice daily or 600 mg once daily for 10 days 3
• Community-acquired pneumonia: 300 mg twice daily for 10 days 3
• Acute bacterial exacerbation of chronic bronchitis: 300 mg twice daily for 5-10 days 4
• Pharyngitis/tonsillitis: 300 mg twice daily for 5-10 days or 600 mg once daily for 10 days 4
• Uncomplicated skin infections: 300 mg twice daily for 10 days (once-daily dosing not recommended for skin infections) 1, 5

Pediatric Dosing Regimens

Standard Pediatric Dosing

• Standard dose: 14 mg/kg/day divided into one or two doses (maximum 600 mg/day) 1, 2
• Renal adjustment: For children with creatinine clearance <30 mL/min/1.73 m², reduce to 7 mg/kg once daily (maximum 300 mg) 1
• Hemodialysis patients: 7 mg/kg every other day with an additional dose after each hemodialysis session 1

Infection-Specific Pediatric Dosing

• Acute bacterial otitis media: 7 mg/kg every 12 hours or 14 mg/kg once daily for 5-10 days 1
• Acute maxillary sinusitis: 7 mg/kg every 12 hours or 14 mg/kg once daily for 10 days 1
• Pharyngitis/tonsillitis: 7 mg/kg every 12 hours or 14 mg/kg once daily for 5-10 days 1
• Uncomplicated skin infections: 7 mg/kg every 12 hours for 10 days (once-daily dosing not studied for skin infections) 1, 6

Weight-Based Pediatric Dosing Chart

For the 125 mg/5 mL suspension:

• 9 kg (20 lbs): 2.5 mL q12h or 5 mL q24h
• 18 kg (40 lbs): 5 mL q12h or 10 mL q24h
• 27 kg (60 lbs): 7.5 mL q12h or 15 mL q24h
• 36 kg (80 lbs): 10 mL q12h or 20 mL q24h
• ≥43 kg (95 lbs): 12 mL q12h or 24 mL q24h 1

Clinical Considerations

Antimicrobial Spectrum

• Effective against: Streptococcus pneumoniae (penicillin-susceptible), Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, methicillin-susceptible Staphylococcus aureus 1, 2
• Limited activity against: Drug-resistant Streptococcus pneumoniae (DRSP), Enterobacter species, Pseudomonas species, Enterococcus species, methicillin-resistant staphylococci 1

Role in Treatment Algorithms

• Respiratory infections: Cefdinir is recommended as an alternative agent for patients with non-Type I penicillin allergies in acute bacterial rhinosinusitis 3
• Pediatric infections: Preferred over other cephalosporins in children due to high patient acceptance and palatability of the suspension 3, 4
• Urinary tract infections: Shows good coverage (95.6%) against common urinary pathogens in children, comparable to other commonly used antibiotics 7

Administration Considerations

• Can be administered without regard to meals 1
• Suspension must be shaken well before each administration 1
• After reconstitution, suspension can be stored at room temperature for 10 days 1

Common Pitfalls and Caveats

• Skin infections: Once-daily dosing has not been studied for skin infections; therefore, cefdinir should be administered twice daily for these infections 1
• Suspension taste: Cefdinir suspension has superior taste/palatability compared to other oral antimicrobial agents, which may improve adherence in pediatric patients 2, 4
• Diarrhea: Diarrhea is the most common adverse event, occurring more frequently with cefdinir than with some comparator agents 4, 5
• Beta-lactamase stability: Cefdinir is stable to hydrolysis by many common beta-lactamases, making it effective against beta-lactamase-producing strains of H. influenzae and M. catarrhalis 4
• Renal function: Dosage adjustment is required in patients with markedly compromised renal function (creatinine clearance <30 mL/min) 1

Cefdinir represents an important cephalosporin option for the treatment of mild to moderate respiratory tract and skin infections, particularly in areas with elevated rates of beta-lactamase production in common pathogens 2.