What is the recommended dosage and treatment duration of cefdinir (Cefdinir) for pediatric patients?

Cefdinir Dosage and Treatment Duration for Pediatric Patients

For pediatric patients aged 6 months through 12 years, cefdinir should be administered at a total daily dose of 14 mg/kg (up to a maximum of 600 mg per day), given either as 14 mg/kg once daily or 7 mg/kg twice daily, with treatment duration varying from 5-10 days depending on the infection type. 1

Recommended Dosing by Infection Type

• Acute Bacterial Otitis Media:

  • Dosage: 14 mg/kg once daily OR 7 mg/kg twice daily
  • Duration: 5-10 days 1

• Acute Maxillary Sinusitis:

  • Dosage: 14 mg/kg once daily OR 7 mg/kg twice daily
  • Duration: 10 days 1, 2

• Pharyngitis/Tonsillitis:

  • Dosage: 14 mg/kg once daily OR 7 mg/kg twice daily
  • Duration: 5-10 days 1

• Uncomplicated Skin and Skin Structure Infections:

  • Dosage: 7 mg/kg twice daily (once-daily dosing not recommended for skin infections)
  • Duration: 10 days 1

Special Considerations

Renal Impairment

• For pediatric patients with creatinine clearance <30 mL/min/1.73 m², the dose should be reduced to 7 mg/kg (up to 300 mg) given once daily 1

Penicillin Allergy

• Cefdinir is a preferred alternative for patients with non-type I hypersensitivity reactions to penicillin (e.g., rash) 2
• For patients with moderate disease or recent antibiotic use, cefdinir is preferred over other cephalosporins due to higher patient acceptance 2

Dosing Convenience

• Once-daily dosing has been shown to be as effective as twice-daily dosing for most infections, except skin infections which require twice-daily administration 1, 3
• Cefdinir can be administered without regard to meals, increasing convenience for pediatric patients 1

Efficacy and Safety Profile

• Cefdinir has demonstrated good clinical and bacteriological efficacy against common respiratory pathogens including Haemophilus influenzae, Moraxella catarrhalis, and penicillin-susceptible Streptococcus pneumoniae 3, 4
• In comparative studies, cefdinir showed similar efficacy to amoxicillin/clavulanate in treating acute otitis media in children 5, 6
• The most common adverse event is diarrhea, though overall discontinuation rates due to adverse events are generally similar to comparator antibiotics 4

Important Clinical Considerations

• For patients with acute bacterial sinusitis who have not responded to initial therapy after 72 hours, consider switching to an alternative antibiotic or reevaluating the patient 2
• Higher doses of cefdinir (25 mg/kg/day) have been studied but were found to be ineffective against penicillin-nonsusceptible S. pneumoniae and had a higher incidence of diarrhea (20%) 7
• Cefdinir suspension may be used for up to 10 days after reconstitution when stored at room temperature, after which any unused portion must be discarded 1

Common Pitfalls to Avoid

• Do not use cefdinir in patients with type I (immediate) hypersensitivity reactions to beta-lactams; instead, consider clindamycin or macrolides 2, 8
• Be aware that macrolides (azithromycin, clarithromycin, erythromycin) have limited effectiveness against major pathogens of acute bacterial rhinosinusitis with potential bacterial failure rates of 20-25% 2
• Do not exceed the maximum daily dose of 600 mg, regardless of weight 1
• Remember that once-daily dosing has not been validated for skin infections; always use twice-daily dosing for these conditions 1