What is the recommended dosage of cefdinir (antibiotic) for treating sinusitis?

Recommended Dosage of Cefdinir for Sinusitis

For sinusitis treatment, cefdinir should be administered at a dose of 300 mg twice daily or 600 mg once daily for 10 days in adults, and 14 mg/kg once daily for 10 days in children. 1

Adult Dosing

• Cefdinir can be administered as 300 mg twice daily or 600 mg once daily for 10 days for acute maxillary sinusitis 2, 1
• Once-daily dosing (600 mg) has been shown to be as effective as twice-daily dosing (300 mg) for sinusitis treatment 1, 3
• Cefdinir can be taken without regard to meals, improving convenience and adherence 1

Pediatric Dosing

• For children aged 6 months through 12 years, the recommended dosage for acute maxillary sinusitis is 14 mg/kg once daily or 7 mg/kg twice daily 1
• The total daily dose should not exceed 600 mg per day 1
• Treatment duration for pediatric sinusitis should be 10 days 1

Clinical Efficacy

• Cefdinir has good in vitro activity against common respiratory pathogens including Haemophilus influenzae, Moraxella catarrhalis, and penicillin-susceptible Streptococcus pneumoniae 4
• Clinical studies have demonstrated that cefdinir is as effective as other recommended antibiotics for sinusitis, including amoxicillin/clavulanate and levofloxacin 5, 3
• In a multicenter, randomized, double-blind study, cefdinir 600 mg once daily for 10 days showed clinical cure rates of 83%, comparable to levofloxacin's 86% 3

Special Populations

• For adult patients with creatinine clearance <30 mL/min, the dose should be reduced to 300 mg once daily 1
• For pediatric patients with creatinine clearance <30 mL/min/1.73 m², the dose should be reduced to 7 mg/kg (up to 300 mg) once daily 1
• For patients on hemodialysis, an initial dose of 300 mg or 7 mg/kg should be given, followed by 300 mg or 7 mg/kg after each hemodialysis session 1

Advantages of Cefdinir

• Cefdinir is stable to hydrolysis by commonly occurring plasmid-mediated beta-lactamases, making it effective against beta-lactamase-producing strains of H. influenzae and M. catarrhalis 4
• It distributes well into respiratory tissues and fluids, including sinus tissue 4, 6
• The oral suspension has superior taste compared to other antibiotics, improving adherence especially in pediatric patients 4, 6

Common Pitfalls and Considerations

• Cefdinir may cause diarrhea more frequently than some other antibiotics, though discontinuation rates due to adverse events are generally similar to comparators 4, 3
• Vaginal moniliasis has been reported in 11% of women taking cefdinir compared to 0% with levofloxacin (p=0.003) 3
• If there is no clinical improvement within 3-5 days of initiating therapy, consider switching to an alternative antibiotic 2
• First-generation cephalosporins (like cephalexin) and some second-generation cephalosporins (like cefaclor) have poor activity against H. influenzae and should not be used for sinusitis 2

Alternative Options

• For patients with penicillin allergy, cefdinir is a suitable alternative 2
• In cases of treatment failure with amoxicillin, cefdinir is an appropriate second-line option 2, 7
• Fluoroquinolones should be reserved for situations with high risk of complications or failure of first-line therapy 7, 8

Cefdinir represents an important treatment option for sinusitis, particularly in areas with elevated rates of beta-lactamase production in common respiratory pathogens 6.