What is the dosage of Cefdnir (Cefdinir) for acute pharyngitis?

Cefdinir Dosage for Acute Pharyngitis

For acute pharyngitis caused by Group A Streptococcus (GAS), cefdinir should be administered at 14 mg/kg once daily (maximum 600 mg) or 7 mg/kg twice daily (maximum 300 mg per dose) for 10 days. 1

Dosing Recommendations

Pediatric Patients (6 months through 12 years)

• Once-daily dosing: 14 mg/kg once daily for 10 days (maximum 600 mg per day) 1
• Twice-daily dosing: 7 mg/kg twice daily for 10 days (maximum 300 mg per dose) 1
• Once-daily dosing has been shown to be as effective as twice-daily dosing for pharyngitis 1, 2

Adolescents and Adults

• Once-daily dosing: 600 mg once daily for 10 days 1, 2
• Twice-daily dosing: 300 mg twice daily for 10 days 1, 2

Clinical Evidence and Rationale

Cefdinir is an oral third-generation cephalosporin with good activity against common respiratory pathogens, including Group A Streptococcus (GAS), which is the most common bacterial cause of acute pharyngitis 3. According to the FDA-approved labeling, cefdinir is indicated for the treatment of pharyngitis/tonsillitis caused by Streptococcus pyogenes 1.

Clinical studies have demonstrated that:

• Cefdinir administered once or twice daily for 10 days is effective for GAS pharyngitis 2
• In comparative trials, cefdinir showed superior bacterial eradication rates (91.4% for once-daily and 91.7% for twice-daily dosing) compared to penicillin V (83.4%) 2
• Clinical cure rates were also higher with cefdinir (94.8% for once-daily and 96.3% for twice-daily) compared to penicillin V (88.9%) 2

Important Considerations

Position in Treatment Algorithm

• While cefdinir is effective for GAS pharyngitis, the Infectious Diseases Society of America (IDSA) guidelines recommend penicillin or amoxicillin as first-line therapy due to their narrow spectrum, infrequency of adverse reactions, and modest cost 4
• Cefdinir should be considered for penicillin-allergic patients who are not anaphylactically sensitive to penicillin 4
• The FDA has approved cefdinir for a 5-day course of therapy for GAS pharyngitis, but the IDSA guidelines note that many studies of short-course cephalosporin therapy lack strict entry criteria and assessment of compliance 4

Dosing in Special Populations

• Renal impairment: For patients with creatinine clearance <30 mL/min, the dose should be reduced to 7 mg/kg (up to 300 mg) once daily 1
• Hemodialysis patients: Initial dose of 300 mg or 7 mg/kg every other day, with an additional dose after each hemodialysis session 1

Common Side Effects

• Diarrhea is the most common adverse event with cefdinir 2, 5
• In clinical trials, diarrhea occurred more frequently with cefdinir than with comparator agents 5
• Despite higher rates of diarrhea, discontinuation rates due to adverse events were generally similar between cefdinir and comparator groups 6

Practical Administration Tips

• Cefdinir may be administered without regard to meals 1
• The oral suspension must be shaken well before each administration and can be stored at room temperature for up to 10 days after reconstitution 1
• The palatability of cefdinir oral suspension has been reported to be superior to other antimicrobial agents, which may enhance adherence in pediatric patients 3, 6