What is the recommended dose of cefdinir (Cefdinir) for a pediatric patient weighing 33 kg with a urinary tract infection (UTI)?

Pediatric Dosing of Cefdinir for UTI in a 33 kg Child

For a 33 kg pediatric patient with a urinary tract infection, the recommended dose of cefdinir is 14 mg/kg/day divided into one or two daily doses, which equals approximately 462 mg/day (either as 231 mg twice daily or 462 mg once daily) for 7-14 days. 1

Dosing Considerations

• Cefdinir is an oral third-generation cephalosporin with good activity against common urinary tract pathogens 1
• For pediatric patients, the standard dosing is 14 mg/kg/day, which can be administered as:
  • Once-daily dosing: 14 mg/kg once daily (462 mg for a 33 kg child)
  • Twice-daily dosing: 7 mg/kg twice daily (231 mg twice daily for a 33 kg child) 1

Duration of Therapy

• The recommended duration for treating UTIs in pediatric patients is 7-14 days 2
• Shorter courses (1-3 days) have been shown to be inferior for febrile UTIs 2

Efficacy for UTIs

• Cefdinir has demonstrated 95.6% susceptibility against common urinary pathogens in pediatric patients, including Escherichia coli, Klebsiella spp, and Proteus spp 3
• This susceptibility rate is comparable or superior to many other commonly used antibiotics for UTIs:
  • Ampicillin (49.4%)
  • Trimethoprim-sulfamethoxazole (84.9%)
  • Cefazolin (88.4%)
  • Nitrofurantoin (93.3%)
  • Ticarcillin-clavulanate (94.2%)
  • Gentamicin (97.5%)
  • Ceftriaxone (97.7%) 3

Alternative Options for UTIs in Pediatric Patients

If cefdinir is unavailable or contraindicated, other empiric oral options include:

• Amoxicillin-clavulanate: 20-40 mg/kg/day divided into 3 doses 2
• Cefixime: 8 mg/kg/day as a single dose 2
• Cefpodoxime: 10 mg/kg/day divided into 2 doses 2
• Cefprozil: 30 mg/kg/day divided into 2 doses 2
• Cephalexin: 50-100 mg/kg/day divided into 4 doses 2

Important Clinical Considerations

• Cefdinir has shown good distribution in tissues and fluids, with a pharmacokinetic profile allowing once or twice daily administration 1
• The oral suspension formulation has demonstrated superior palatability compared to other oral antimicrobial agents, which may improve adherence in pediatric patients 1
• For patients who appear toxic or unable to tolerate oral medications, consider initial parenteral therapy until clinical improvement occurs (typically within 24-48 hours) 2
• Local antimicrobial sensitivity patterns should guide empiric therapy choices, with adjustment based on culture results when available 2

Potential Adverse Effects

• The most common side effects observed with cefdinir in pediatric patients are gastrointestinal, including diarrhea and loose stools (reported in approximately 12.5% of cases) 4, 5
• These side effects are generally mild and rarely require discontinuation of therapy 5