Cefdinir Treatment for Acute Otitis Media
For acute otitis media (AOM), cefdinir should be dosed at 14 mg/kg once daily for 10 days or 7 mg/kg twice daily for 5-10 days in children, with a maximum daily dose of 600 mg. 1
Dosage Recommendations
Pediatric Patients (6 months through 12 years)
- Once-daily dosing: 14 mg/kg once daily for 10 days
- Twice-daily dosing: 7 mg/kg every 12 hours for 5-10 days
- Maximum daily dose: 600 mg
Adults
- 300 mg twice daily for 5-10 days (based on adult dosing principles, though specific AOM dosing is not explicitly stated in the evidence)
Treatment Duration
Clinical Considerations
Position in Treatment Algorithm
- Cefdinir is not a first-line agent for AOM
- It should be considered as an alternative antibiotic for:
Efficacy Considerations
- High-dose amoxicillin/clavulanic acid (10-day course) has shown superior efficacy compared to 5-day cefdinir treatment in children 6-24 months old with AOM (86.5% vs 71.0% cure rate) 4
- Cefdinir efficacy decreases with increasing age in children between 6-24 months 4
- Cefdinir shows reduced effectiveness against penicillin-resistant S. pneumoniae:
- 91% eradication for penicillin-susceptible strains
- 67% for penicillin-intermediate strains
- Only 43% for penicillin-resistant strains 5
Special Populations
- Renal impairment: For patients with creatinine clearance <30 mL/min:
- Adults: 300 mg once daily
- Children: 7 mg/kg once daily (up to 300 mg) 1
- Hemodialysis patients: 300 mg or 7 mg/kg every other day, with an additional dose after each hemodialysis session 1
Administration Guidelines
- Can be administered without regard to meals 1
- Available as oral suspension (125 mg/5 mL or 250 mg/5 mL) 1
- After reconstitution, suspension can be stored at room temperature for 10 days 1
Common Adverse Effects
- Diarrhea (most common, occurring in approximately 11% of patients) 1, 3
- Generally well-tolerated with discontinuation rates similar to comparator antibiotics 3
Important Clinical Pearls
- Diagnostic accuracy is crucial: Ensure proper diagnosis of AOM using pneumatic otoscopy to assess tympanic membrane color, opacity, position, and mobility before prescribing antibiotics 2
- Proper patient selection: Cefdinir may be most appropriate for patients with beta-lactamase-producing pathogens or penicillin allergy 2, 3
- Resistance concerns: Be aware of potentially reduced efficacy against penicillin-resistant S. pneumoniae 5
- Weight-based dosing: Ensure accurate weight-based dosing in pediatric patients 1
For optimal outcomes in AOM treatment, accurate diagnosis followed by appropriate antibiotic selection based on patient factors and local resistance patterns remains essential.