Cefdinir Dosing for Bacterial Infections
The recommended dosing for cefdinir in bacterial infections is 300 mg twice daily or 600 mg once daily for adults, and 14 mg/kg/day divided into one or two doses (maximum 600 mg/day) for pediatric patients. 1
Adult Dosing
Standard Dosing
- 300 mg twice daily or 600 mg once daily for 10 days for most infections 1, 2
- Can be administered without regard to meals 1
- Once-daily dosing is as effective as twice-daily dosing for most infections, except skin infections which require twice-daily administration 1, 3
Specific Indications and Duration
- Community-acquired pneumonia: 300 mg twice daily or 600 mg once daily for 10 days 4
- Acute bacterial exacerbation of chronic bronchitis: 300 mg twice daily or 600 mg once daily for 5-10 days 4, 3
- Acute maxillary sinusitis: 300 mg twice daily or 600 mg once daily for 10 days 1, 5
- Pharyngitis/tonsillitis: 300 mg twice daily or 600 mg once daily for 5-10 days 1, 4
- Uncomplicated skin and skin structure infections: 300 mg twice daily for 10 days 1, 3
Pediatric Dosing (6 months through 12 years)
Standard Dosing
- Total daily dose: 14 mg/kg/day, up to maximum 600 mg per day 1
- Can be administered as a single daily dose or divided into two doses 1
- Can be administered without regard to meals 1
Specific Indications and Duration
- Acute bacterial otitis media: 7 mg/kg every 12 hours or 14 mg/kg once daily for 5-10 days 1
- Acute maxillary sinusitis: 7 mg/kg every 12 hours or 14 mg/kg once daily for 10 days 1
- Pharyngitis/tonsillitis: 7 mg/kg every 12 hours or 14 mg/kg once daily for 5-10 days 1
- Uncomplicated skin and skin structure infections: 7 mg/kg every 12 hours for 10 days (note: once-daily dosing not recommended for skin infections) 1
Dosing in Special Populations
Renal Impairment
- For adults with creatinine clearance <30 mL/min: 300 mg once daily 1
- For pediatric patients with creatinine clearance <30 mL/min/1.73 m²: 7 mg/kg (up to 300 mg) once daily 1
Hemodialysis Patients
- Initial dose: 300 mg or 7 mg/kg every other day 1
- At conclusion of each hemodialysis session: 300 mg or 7 mg/kg 1
- Subsequent doses: 300 mg or 7 mg/kg every other day 1
Clinical Considerations
Antimicrobial Spectrum
- Effective against common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 2, 4
- Active against Staphylococcus aureus (methicillin-susceptible strains) and Streptococcus pyogenes 4, 3
- Stable to hydrolysis by many common beta-lactamases, maintaining activity against beta-lactamase-producing strains of H. influenzae and M. catarrhalis 2, 3
Advantages
- Convenient once or twice daily dosing improves adherence 2, 3
- Good tissue penetration in respiratory tract, middle ear, and skin 2, 3
- Oral suspension has superior palatability compared to other antibiotics, improving acceptance in pediatric patients 2
Common Adverse Effects
- Diarrhea (most common, approximately 20% of patients) 5
- Generally well-tolerated with adverse event profile similar to comparator agents 4, 3
Important Considerations and Pitfalls
- Once-daily dosing has not been studied for skin infections, so twice-daily dosing must be used for these conditions 1
- After reconstitution, oral suspension can be stored at room temperature for 10 days, after which any unused portion must be discarded 1
- Suspension should be shaken well before each administration 1
- Cefdinir is an alternative to first-line antimicrobial agents, particularly in areas with high rates of beta-lactamase production 2, 6
- Drug interactions: Antacids containing aluminum or magnesium and iron supplements may decrease absorption of cefdinir; separate administration by at least 2 hours 3
By following these dosing recommendations, clinicians can optimize the efficacy of cefdinir while minimizing the risk of adverse effects and antimicrobial resistance.