Pediatric Dosage of Cefdinir for Treating Ear Infections
For treating acute otitis media (ear infections) in children, the recommended dosage of cefdinir (Omnicef) is 14 mg/kg/day given once daily or 7 mg/kg twice daily for 5 to 10 days, with a maximum daily dose of 600 mg. 1
Dosing Guidelines
The FDA-approved dosage for acute bacterial otitis media in pediatric patients (6 months through 12 years) is:
- 7 mg/kg every 12 hours for 5 to 10 days, OR
- 14 mg/kg once daily for 10 days 1
Once-daily dosing for 10 days has been shown to be as effective as twice-daily dosing for ear infections 1, 2
The maximum daily dose should not exceed 600 mg, regardless of weight 1
Weight-Based Dosing Chart
For the 125 mg/5 mL suspension:
- 9 kg (20 lbs): 2.5 mL every 12 hours or 5 mL once daily 1
- 18 kg (40 lbs): 5 mL every 12 hours or 10 mL once daily 1
- 27 kg (60 lbs): 7.5 mL every 12 hours or 15 mL once daily 1
- 36 kg (80 lbs): 10 mL every 12 hours or 20 mL once daily 1
- ≥43 kg (95 lbs): 12 mL every 12 hours or 24 mL once daily 1
For the 250 mg/5 mL suspension:
- 18 kg (40 lbs): 2.5 mL every 12 hours or 5 mL once daily 1
- 27 kg (60 lbs): 3.75 mL every 12 hours or 7.5 mL once daily 1
- 36 kg (80 lbs): 5 mL every 12 hours or 10 mL once daily 1
- ≥43 kg (95 lbs): 6 mL every 12 hours or 12 mL once daily 1
Clinical Efficacy and Treatment Duration
The American Academy of Pediatrics recommends cefdinir as an alternative treatment for acute otitis media when patients have penicillin allergy 3
Clinical studies have shown that a 5-day course of cefdinir at 14 mg/kg/day is as effective as a 10-day course of cefprozil for treating acute otitis media in children 4
However, comparative studies have shown that high-dose amoxicillin/clavulanic acid for 10 days has a better cure rate (86.5%) than cefdinir for 5 days (71.0%) in children with acute otitis media 5
Special Considerations
For children with renal insufficiency (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
Cefdinir is stable against commonly occurring plasmid-mediated beta-lactamases and retains good activity against beta-lactamase-producing strains of H. influenzae and M. catarrhalis, which are common causes of otitis media 6
For children with recurrent or persistent otitis media at high risk of treatment failure, some studies have investigated higher doses of cefdinir (25 mg/kg once daily for 10 days), though this is not an FDA-approved dosing regimen 7
Cefdinir can be administered without regard to meals, which improves compliance in pediatric patients 1
The suspension should be shaken well before each administration and can be used for 10 days after mixing, after which any unused portion must be discarded 1
Potential Pitfalls and Caveats
Diarrhea is the most common adverse event reported with cefdinir treatment in pediatric patients 6
The efficacy of cefdinir decreases against penicillin-nonsusceptible S. pneumoniae strains, with eradication rates of 91% for penicillin-susceptible strains but only 43% for penicillin-resistant strains 7
In areas with high prevalence of penicillin-resistant S. pneumoniae, cefdinir may not be the optimal first-line choice for treating otitis media 5, 7
For children on hemodialysis, the dose should be adjusted to 7 mg/kg every other day, with an additional dose after each hemodialysis session 1