Cefdinir Dosage and Usage Guidelines
Cefdinir is an extended-spectrum semisynthetic oral cephalosporin that should be dosed at 300 mg twice daily or 600 mg once daily for adults, and 14 mg/kg/day in one or two divided doses for children, with treatment duration typically 5-10 days depending on the infection being treated. 1, 2
Adult Dosing
- For adults with respiratory tract infections (community-acquired pneumonia, acute bacterial rhinosinusitis, pharyngitis/tonsillitis), the recommended dose is 300 mg twice daily or 600 mg once daily for 10 days 1, 3
- For uncomplicated skin and skin structure infections in adults, cefdinir should be administered at 300 mg twice daily for 10 days 1, 4
- Once-daily dosing (600 mg) has been shown to be as effective as twice-daily dosing (300 mg) for most respiratory infections, offering greater convenience 2, 5
Pediatric Dosing
- For children 6 months through 12 years, the total daily dose is 14 mg/kg, up to a maximum of 600 mg per day 1
- For acute bacterial otitis media: 7 mg/kg every 12 hours or 14 mg/kg once daily for 5-10 days 1
- For acute maxillary sinusitis: 7 mg/kg every 12 hours or 14 mg/kg once daily for 10 days 1
- For pharyngitis/tonsillitis: 7 mg/kg every 12 hours or 14 mg/kg once daily for 5-10 days 1
- For uncomplicated skin infections: 7 mg/kg every 12 hours for 10 days (once-daily dosing not recommended for skin infections) 1, 6
Special Populations
- For adult patients with renal insufficiency (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, administer 300 mg or 7 mg/kg every other day, with an additional dose after each hemodialysis session 1
- Elderly patients do not require dosage adjustment unless they have markedly compromised renal function 1
Antimicrobial Spectrum and Clinical Applications
- Cefdinir is effective against common respiratory pathogens including Streptococcus pneumoniae (penicillin-susceptible strains), Haemophilus influenzae, and Moraxella catarrhalis 7, 1
- For bacterial sinusitis, cefdinir is recommended as an alternative to amoxicillin or amoxicillin/clavulanate, particularly in patients with mild disease who have not received antibiotics in the previous 4-6 weeks 7
- For community-acquired pneumonia, cefdinir is listed as an alternative oral agent for treating Streptococcus pneumoniae infections 7
- For skin and skin structure infections, cefdinir has demonstrated high clinical cure rates (98.3%) and microbiologic eradication rates (99.4%) in pediatric patients 6
Administration Considerations
- Cefdinir can be administered without regard to meals 1
- The oral suspension must be shaken well before each administration and can be stored at room temperature for up to 10 days after reconstitution 1
- The suspension has shown superior taste and palatability compared to other oral antimicrobial agents, potentially improving adherence, especially in pediatric patients 2, 3
Common Pitfalls and Caveats
- Cefdinir is inactive against most strains of Enterobacter spp., Pseudomonas spp., Enterococcus spp., penicillin-resistant streptococci, and methicillin-resistant staphylococci 1
- Beta-lactamase negative, ampicillin-resistant (BLNAR) H. influenzae strains are typically non-susceptible to cefdinir 1
- Diarrhea is the most common adverse event, occurring in approximately 15-20% of patients 3, 5
- Iron supplements, antacids, or multivitamins containing iron may reduce absorption of cefdinir; separate administration by at least 2 hours 3
- For patients with true Type I hypersensitivity to penicillin, there is potential for cross-reactivity with cephalosporins; alternative agents should be considered 8
By following these dosing guidelines and considering the specific infection being treated, cefdinir can be an effective antibiotic option with the convenience of once or twice daily dosing for most indications.