What is the dose of cefdinir (Cefdinir) in children?

From the Guidelines

Cefdinir should be dosed at 14 mg/kg/day divided into one or two doses, with a maximum daily dose of 600 mg, in children with acute bacterial sinusitis who are hypersensitive to amoxicillin. The dosing of cefdinir in children is crucial for effective treatment of bacterial infections while minimizing potential side effects. According to the American Academy of Pediatrics guideline on diagnosis and management of acute bacterial sinusitis in children one to 18 years of age 1, cefdinir is an alternative treatment option for children with hypersensitivity to amoxicillin. Key considerations for cefdinir dosing in children include:

• Weight-based dosing to ensure appropriate drug exposure
• Type of infection being treated, which may influence the duration of therapy
• Potential for side effects, such as diarrhea and diaper rash
• Importance of shaking the oral suspension well before measuring each dose
• Storage at room temperature for 10 days after reconstitution It is essential to note that cefdinir may cause reddish stools when iron supplements or iron-fortified formula/foods are consumed simultaneously, which is a harmless chemical reaction. Additionally, caution should be used in children with a penicillin allergy due to potential cross-reactivity with cephalosporins like cefdinir.

From the FDA Drug Label

The recommended dosage and duration of treatment for infections in pediatric patients are described in the following chart; the total daily dose for all infections is 14 mg/kg, up to a maximum dose of 600 mg per day. Pediatric Patients (Age 6 Months Through 12 Years) Type of Infection Dosage Duration Acute Bacterial Otitis Media 7 mg/kg q12h or 14 mg/kg q24h 5 to 10 days 10 days Acute Maxillary Sinusitis 7 mg/kg q12h or 14 mg/kg q24h 10 days 10 days Pharyngitis/Tonsillitis 7 mg/kg q12h or 14 mg/kg q24h 5 to 10 days 10 days Uncomplicated Skin and Skin Structure Infections 7 mg/kg q12h 10 days

The dose of cefdinir in children is 7-14 mg/kg per day, up to a maximum dose of 600 mg per day, divided into once-daily or twice-daily doses, depending on the type of infection and patient age, as outlined in the dosage chart 2.

• For patients who weigh ≥ 43 kg, the maximum daily dose is 600 mg.
• The dosage may need to be adjusted for patients with renal insufficiency, with a recommended dose of 7 mg/kg (up to 300 mg) given once daily for pediatric patients with a creatinine clearance of <30 mL/min/1.73 m2 2.

From the Research

Cefdinir Dosage in Children

The dosage of cefdinir in children varies based on the study and the specific condition being treated.

• According to 3, the recommended dose is 14 mg/kg/day in one or two daily doses in pediatric patients.
• A study published in 4 suggests a daily dose of 9-18 mg/kg, administered in 3 divided portions.
• In 5, two dosage regimens of cefdinir were compared: 14 mg/kg daily (QD) and 7 mg/kg twice a day (BID).
• Another study 6 used a dosage range of 8.1 to 15.9 mg/kg/day.
• A high-dose study 7 used 25 mg/kg oral suspension once daily for 10 days in children with acute otitis media at high risk of persistent or recurrent infection.

Dosage Considerations

When considering the dosage of cefdinir in children, it's essential to take into account the specific condition being treated and the potential for side effects.

• Increase of dose may be associated with an increase of gastrointestinal side effects, as noted in 4.
• The most common treatment-associated adverse reaction in all groups was diarrhea, as seen in 5.
• A pharmacokinetic study in 6 showed that serum concentrations of cefdinir peaked at 2 hours after dosing, with 8-hour urinary excretion rates ranging from 10.9 to 21.3%.

Efficacy and Safety

The efficacy and safety of cefdinir in children have been evaluated in several studies.

• In 3, cefdinir showed good clinical and bacteriological efficacy in pediatric patients with community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, sinusitis, acute otitis media, pharyngitis, and uncomplicated skin and skin structure infections.
• A study published in 5 found that a 10-day regimen of cefdinir 14 mg/kg QD or 7 mg/kg BID was as clinically effective overall as a 10-day regimen of amoxicillin/clavulanate 40/10 mg/kg/day divided TID in the treatment of tympanocentesis-confirmed, nonrefractory AOM in children.
• In 7, large dose cefdinir resulted in an overall successful clinical response at end of treatment of 83% in children with acute otitis media at high risk of persistent or recurrent infection.