Can cefdinir be used to treat an infection in the triangular fossa?

Treatment of Triangular Fossa Infection with Cefdinir

Cefdinir is an appropriate antibiotic choice for treating an infection in the triangular fossa of the ear, as it has good activity against common pathogens that cause skin and skin structure infections. 1, 2

Rationale for Using Cefdinir

• Cefdinir is an extended-spectrum semisynthetic oral cephalosporin with broad-spectrum activity against many gram-positive and gram-negative aerobic organisms commonly responsible for skin and skin structure infections 3
• It demonstrates good activity against Staphylococcus aureus and Streptococcus pyogenes, which are common pathogens in skin infections, including those of the ear 2
• Cefdinir is stable to hydrolysis by 13 of the common beta-lactamases, making it effective against beta-lactamase-producing strains that might be present in skin infections 1
• The drug distributes well into various tissues and has a pharmacokinetic profile allowing for convenient once- or twice-daily administration 4

Dosing Recommendations

• For adults and adolescents: 300 mg twice daily or 600 mg once daily for 10 days 4
• For pediatric patients: 14 mg/kg/day divided into one or two daily doses 4
• Dosing should be adjusted in patients with significant renal impairment 1

Clinical Evidence Supporting Use

• Clinical trials have demonstrated good efficacy of cefdinir in treating uncomplicated skin and skin structure infections, with outcomes comparable to other commonly used antibiotics 2
• Cefdinir has shown equivalent efficacy to cefalexin in treating uncomplicated skin infections in both adults and pediatric patients 1
• The antimicrobial guidelines recognize cefdinir as an appropriate option for skin infections, with activity comparable to second-generation agents like cefuroxime axetil 5

Advantages of Cefdinir

• Once- or twice-daily dosing improves patient adherence compared to more frequently dosed antibiotics 6
• Generally well-tolerated with a safety profile similar to other oral cephalosporins 1
• The oral suspension has superior taste/palatability compared to many other antimicrobial agents, which may improve compliance 4
• Effective against beta-lactamase-producing organisms that may be resistant to other commonly used antibiotics 1

Potential Limitations and Side Effects

• Diarrhea is the most common adverse event reported with cefdinir, occurring more frequently than with some comparator antibiotics 1
• Should be used with caution in patients with penicillin allergy due to potential cross-reactivity 3
• Not recommended for infections caused by MRSA or other resistant organisms that may require alternative therapy 5
• Food can decrease the rate but not the extent of absorption; can be taken without regard to meals 6

Alternative Options if Cefdinir is Not Appropriate

• For mild infections: amoxicillin/clavulanate, cefuroxime axetil, or cefpodoxime proxetil 5
• For patients with beta-lactam allergies: clindamycin (for gram-positive coverage) 5
• For more severe infections or treatment failures: consider respiratory fluoroquinolones (in adults) or parenteral therapy with ceftriaxone 5

Cefdinir represents a good option for treating infections of the triangular fossa due to its spectrum of activity, convenient dosing, and established efficacy in skin and skin structure infections 4, 1, 2.