What is the recommended dosing of cefdinir (Omnicef) for streptococcal (strep) infections?

From the Guidelines

Cefdinir is not recommended as a first-line treatment for streptococcal pharyngitis, and its dosing is not specified in the provided guideline evidence. The recommended antibiotic regimens for group A streptococcal pharyngitis are outlined in the 2012 update by the Infectious Diseases Society of America 1. For individuals without penicillin allergy, the recommended options include:

• Penicillin V, oral: Children: 250 mg twice daily or 3 times daily; adolescents and adults: 250 mg 4 times daily or 500 mg twice daily for 10 days
• Amoxicillin, oral: 50 mg/kg once daily (max = 1000 mg); alternate: 25 mg/kg (max = 500 mg) twice daily for 10 days
• Benzathine penicillin G, intramuscular: <27 kg: 600 000 U; ≥27 kg: 1 200 000 U for 1 dose For individuals with penicillin allergy, the recommended options include:
• Cephalexin, oral: 20 mg/kg/dose twice daily (max = 500 mg/dose) for 10 days
• Cefadroxil, oral: 30 mg/kg once daily (max = 1 g) for 10 days
• Clindamycin, oral: 7 mg/kg/dose 3 times daily (max = 300 mg/dose) for 10 days
• Azithromycin, oral: 12 mg/kg once daily (max = 500 mg) for 5 days
• Clarithromycin, oral: 7.5 mg/kg/dose twice daily (max = 250 mg/dose) for 10 days It's essential to note that cefdinir is not mentioned in the guideline as a recommended treatment option for streptococcal pharyngitis, and its use should be guided by other evidence-based recommendations or clinical judgment. The treatment duration for strep throat is usually 10 days to ensure complete eradication of the bacteria, as stated in the guideline 1. Completing the full course of antibiotics is crucial, even if symptoms improve before the medication is finished, to prevent recurrence and complications. Common side effects of antibiotics may include diarrhea, nausea, and rash, and patients with severe renal impairment may require dose adjustments. However, without specific guidance on cefdinir dosing for streptococcal pharyngitis in the provided evidence, it's challenging to provide a definitive recommendation for its use in this context.

From the FDA Drug Label

Streptococcal Pharyngitis /TonsillitisIn four controlled studies conducted in the United States, cefdinir was compared with 10 days of penicillin in adult, adolescent, and pediatric patients. Two studies (one in adults and adolescents, the other in pediatric patients) compared 10 days of cefdinir q.d. or b.i.d. to penicillin 250 mg or 10 mg/kg q.i. d.

Pharyngitis /Tonsillitis Studies Cefdinir (10 days) vs Penicillin (10 days) Study Efficacy Parameter Cefdinir q.d. Cefdinir b.i.d. Penicillin q.i. d. Outco me Adults/ Ado lescents Eradication of S. pyogenes Clinical Cure Rates 192/210 (91%) 199 /217 (92%) 181/217(83%) Cefdinir superior to control 199 /210 (95%) 209 /217(96 %) 193/217(89 %) Cefdinir superior to control Pediatric Patients Eradication of S pyogenes Clinical Cure Rates 215/228(94%) 214/227(94%) 159/227(70%) Cefdinir superior to control 222/228(97%) 218/227(96%) 196/227(86%) Cefdinir superior to control

Two studies (one in adults and adolescents, the other in pediatric patients) compared 5 days of cefdinir b.i.d. to 10 days of penicillin 250 mg or 10 mg/kg q.i.d.

The recommended dosing of cefdinir (Omnicef) for streptococcal (strep) infections is:

• 10 days of cefdinir q.d. or b.i.d.
• Alternatively, 5 days of cefdinir b.i.d. 2

From the Research

Recommended Dosing of Cefdinir for Streptococcal Infections

• The recommended dosing of cefdinir for streptococcal infections is as follows:
  • For adults and adolescents, cefdinir can be administered at a dose of 600 mg once daily or 300 mg twice daily for 5-10 days 3, 4
  • For pediatric patients, cefdinir can be administered at a dose of 7 mg/kg twice daily for 5 days 5 or 14 mg/kg/day in one or two daily doses for 5-10 days 3
• Cefdinir has been shown to be effective in the treatment of streptococcal pharyngitis, with eradication rates of 90-92% 5, 4
• Cefdinir has also been compared to penicillin V in the treatment of streptococcal pharyngitis, with cefdinir showing superior eradication rates and clinical cure rates 5, 4

Efficacy and Safety of Cefdinir

• Cefdinir has been shown to be effective in the treatment of various bacterial infections, including respiratory tract infections and skin and skin structure infections 6, 3
• Cefdinir has a broad spectrum of antibacterial activity and is stable to hydrolysis by commonly occurring plasmid-mediated beta-lactamases 6
• Cefdinir is generally well tolerated, with the most common adverse event being diarrhea 6, 3, 4, 7