Cefdinir Dosing for Community-Acquired Pneumonia
For community-acquired pneumonia, cefdinir is recommended as an alternative oral therapy at a dose of 14 mg/kg/day divided into one or two daily doses for pediatric patients, with a duration of 5-10 days depending on severity. 1
Pediatric Dosing
- Cefdinir is listed as an alternative oral therapy option for Haemophilus influenzae infections (particularly β-lactamase producing strains) in community-acquired pneumonia 2
- The recommended pediatric dosage is 14 mg/kg/day in one or two daily doses 1
- For respiratory tract infections, twice-daily administration is more effective than once-daily dosing for producing adequate bacterial killing and preventing regrowth 3
- Maximum daily dose should not exceed adult doses (typically 600 mg/day) 2
Adult Dosing
- For adults with community-acquired pneumonia, cefdinir can be administered as 300 mg twice daily or 600 mg once daily 1, 4
- Twice-daily administration (300 mg BID) is preferred for respiratory tract infections to ensure optimal pharmacodynamic effects against common respiratory pathogens 3
- Treatment duration is typically 5-10 days, with 10-day courses being most extensively studied 2, 1
Clinical Considerations
- Cefdinir is not a first-line agent for community-acquired pneumonia; amoxicillin remains the preferred first-line therapy for presumed bacterial pneumonia at 90 mg/kg/day in 2 doses for children 5, 6
- Cefdinir should be considered when there is concern for β-lactamase producing organisms like H. influenzae and M. catarrhalis 7
- Cefdinir has good tissue distribution in respiratory tract tissues and fluids, making it appropriate for respiratory infections 1, 7
- For atypical pneumonia (Mycoplasma pneumoniae or Chlamydophila pneumoniae), macrolides like azithromycin are preferred over cefdinir 5
Important Caveats
- Cefdinir is ineffective against atypical pathogens (Mycoplasma, Chlamydophila) that commonly cause community-acquired pneumonia, particularly in children over 5 years of age 5
- Patients should demonstrate clinical improvement within 48-72 hours of starting appropriate therapy; if not, reassessment is necessary 2
- Diarrhea is the most common adverse effect of cefdinir, occurring in approximately 20% of patients 8
- Cefdinir should not be used as monotherapy if MRSA is suspected; in such cases, consider adding clindamycin (30-40 mg/kg/day in 3-4 doses for children) 5
- Cefdinir absorption may be reduced when taken with iron supplements or iron-fortified foods; separate administration by at least 2 hours 7
Treatment Duration
- Standard treatment courses of 10 days have been best studied, although shorter courses (5 days) may be effective for milder cases 2, 1
- Treatment should continue until the patient has been afebrile for at least 48-72 hours and showing clinical improvement 2, 6
- Longer treatment courses may be necessary for complicated infections or those caused by certain pathogens like S. aureus 2