What is the recommended dose of cefdinir (Cefdinir) for a 7-year-old child with otitis media?

Cefdinir Dosing for Otitis Media in a 7-Year-Old

The recommended dose of cefdinir for a 7-year-old child with otitis media is 14 mg/kg/day, which can be given either as a single daily dose or divided into two doses, for a duration of 5-10 days. 1

Dosing Specifics

• Calculate the total daily dose as 14 mg/kg/day based on the child's weight 1
• This can be administered either:
  • As a single daily dose (14 mg/kg once daily), OR
  • Divided into two doses (7 mg/kg twice daily) 1, 2
• Treatment duration should be 5-10 days 1, 3

When Cefdinir is Appropriate

Cefdinir is not first-line therapy for otitis media. Consider it in these specific scenarios:

• Penicillin allergy (non-anaphylactic type) 1
• Recent antibiotic use within the past 4-6 weeks 1
• Patient acceptance concerns where palatability is important, as cefdinir has superior taste compared to other oral antibiotics 1

Amoxicillin at 80-90 mg/kg/day remains the first-line treatment for most children with acute otitis media 1

Important Clinical Caveats

Efficacy Considerations

• Cefdinir has limitations against penicillin-nonsusceptible Streptococcus pneumoniae 4, 5
• A comparative study showed that 10 days of high-dose amoxicillin/clavulanate (86.5% cure rate) was significantly more effective than 5 days of cefdinir (71.0% cure rate) in children 6-24 months old 5
• The efficacy of cefdinir decreases as children increase in age and weight, suggesting the 14 mg/kg dose may be suboptimal for larger children 5
• Even a higher dose of 25 mg/kg daily was found ineffective for penicillin-nonsusceptible S. pneumoniae strains 4

Tolerability

• Diarrhea is the most common adverse effect, occurring in approximately 10-20% of patients receiving cefdinir 6, 4
• However, cefdinir causes significantly less diarrhea than amoxicillin/clavulanate (10-13% vs 35%) 6

Dosing Schedule Preference

• Once-daily dosing (14 mg/kg QD) may be superior to twice-daily dosing (7 mg/kg BID) for pneumococcal eradication, with an 80% eradication rate for once-daily versus 55.2% for twice-daily dosing 6
• The once-daily regimen offers better compliance and potentially better outcomes for refractory cases 6

Practical Application

For a typical 7-year-old weighing approximately 23 kg (50 lbs):

• Total daily dose: 14 mg/kg × 23 kg = 322 mg/day
• This can be given as 300 mg once daily (using available suspension or capsule formulations) 2, 3