From the Guidelines
Cefdinir is not the first-line treatment for acute otitis media, but it can be considered as a second-line option in patients with penicillin allergy or when first-line treatments have failed. According to the most recent guideline evidence from 2024 1, amoxicillin is recommended as the first-line therapy for acute otitis media due to its efficacy, safety profile, and lower cost. The guideline suggests that amoxicillin or amoxicillineclavulanic acid can be used as the first and second choice for treating acute otitis media, respectively. Cefdinir, although not explicitly recommended as a first or second choice, can be considered as an alternative option in certain cases.
Key Points to Consider
- Amoxicillin is the preferred first-line treatment for acute otitis media due to its effectiveness and safety profile 1
- Cefdinir can be used as a second-line option in patients with penicillin allergy or when first-line treatments have failed
- The typical dosage for children is 14 mg/kg/day divided into one or two doses for 5-10 days, with a maximum of 600 mg daily
- For adults, the usual dose is 300 mg twice daily for 5-10 days
- Cefdinir has good coverage against common otitis media pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
Important Considerations
- The choice of antibiotic should be based on the anticipated clinical response and the microbiologic flora likely to be present 1
- A strategy of watchful waiting could reduce unnecessary antibiotic use, unless the child is younger than 2 years with bilateral otitis media 1
- Common side effects of cefdinir include diarrhea, nausea, and rash, and the medication can be taken with or without food, though taking it with food may help reduce stomach upset.
From the FDA Drug Label
Pediatric Patients Acute Bacterial Otitis Media caused by Haemophilus influenzae (including β-lactamase producing strains), Streptococcus pneumoniae (penicillin-susceptible strains only), and Moraxella catarrhalis (including β-lactamase producing strains)
Cefdinir is effective for treating acute bacterial otitis media caused by susceptible strains of Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis in pediatric patients 2.
From the Research
Efficacy of Cefdinir for Acute Otitis Media
- Cefdinir is considered a possible second-line alternative to amoxicillin for children with acute otitis media (AOM), particularly among children who are likely to be noncompliant with a two- to three-times-daily dosing schedule, and those instances where there is a high likelihood for, or a known infection with an amoxicillin-resistant pathogen 3.
- A study comparing amoxicillin/clavulanic acid high dose with cefdinir in the treatment of AOM found that high-dose amoxicillin/clavulanic acid-treated children had a better cure rate (86.5%) than cefdinir-treated patients (71.0%; p = 0.001) 4.
- Another study found that cefdinir was as clinically effective overall as amoxicillin/clavulanate in the treatment of tympanocentesis-confirmed, nonrefractory AOM in children, with a 10-day regimen of cefdinir 14 mg/kg QD or 7 mg/kg BID being equivalent to a 10-day regimen of amoxicillin/clavulanate 40/10 mg/kg/day divided TID 5.
- A study comparing cefdinir versus amoxicillin/clavulanic acid in the treatment of suppurative acute otitis media in children found that response rates in the three treatment groups were similar, and overall rates of adverse events were statistically lower in the cefdinir once-daily group than in the amoxicillin/CA group 6.
Comparison with Other Antibiotics
- High-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) remains the drug of choice for treatment of acute otitis media despite increasing antimicrobial resistance, with cefdinir being a recommended alternative for persistent or recurrent AOM 7.
- Cefdinir has been compared to amoxicillin/clavulanate in several studies, with varying results, but is generally considered a safe and effective treatment for pediatric patients with acute suppurative otitis media 4, 5, 6.
Safety and Tolerability
- Cefdinir has been found to have a lower rate of gastrointestinal adverse reactions compared to amoxicillin/clavulanate, with diarrhea being the most common adverse event in all treatment groups 5, 6.
- The safety and efficacy of cefdinir in the treatment of AOM have been established in several studies, with cefdinir being considered a safe and effective alternative to amoxicillin/clavulanate 3, 5, 6.