What is the recommended dose of cefdinir (Cefdinir) for a 2-year-old child?

Cefdinir Dosing for a 2-Year-Old

For a 2-year-old child, cefdinir should be dosed at 14 mg/kg/day, which can be given as either 7 mg/kg every 12 hours or 14 mg/kg once daily, with a maximum daily dose of 600 mg. 1

Standard Dosing Regimen

The FDA-approved dosing for pediatric patients aged 6 months through 12 years is 1:

• Total daily dose: 14 mg/kg/day (maximum 600 mg/day)
• Twice-daily option: 7 mg/kg every 12 hours
• Once-daily option: 14 mg/kg every 24 hours

Indication-Specific Considerations

Once-Daily vs. Twice-Daily Dosing

• Once-daily dosing (14 mg/kg every 24 hours) for 10 days is as effective as twice-daily dosing for acute otitis media, sinusitis, and pharyngitis/tonsillitis 1
• Skin infections require twice-daily dosing (7 mg/kg every 12 hours) because once-daily dosing has not been studied for this indication 1

Duration of Therapy

• Acute otitis media: 5-10 days (once-daily) or 10 days (twice-daily) 1
• Acute maxillary sinusitis: 10 days 1
• Pharyngitis/tonsillitis: 5-10 days (once-daily) or 10 days (twice-daily) 1
• Skin infections: 10 days (twice-daily only) 1

Practical Weight-Based Dosing Examples

For a typical 2-year-old weighing approximately 12 kg (26 lbs) 1:

• Twice-daily regimen: 84 mg every 12 hours (total 168 mg/day)
• Once-daily regimen: 168 mg every 24 hours

Using the 125 mg/5 mL suspension, this translates to approximately 3.4 mL per dose for twice-daily dosing 1

Clinical Context from Guidelines

While cefdinir is mentioned as an alternative oral therapy for β-lactamase-producing Haemophilus influenzae infections in pediatric pneumonia guidelines 2, it is not a first-line agent. The guidelines list cefdinir alongside cefixime, cefpodoxime, and ceftibuten as alternatives when amoxicillin-clavulanate cannot be used 2

Important Caveats

Limitations Against Resistant Organisms

• Cefdinir at standard dosing (14 mg/kg/day) is only effective against penicillin-susceptible Streptococcus pneumoniae 1, 3
• Higher doses (25 mg/kg/day) have been studied but remain inadequate for penicillin-nonsusceptible S. pneumoniae, with pharmacodynamic parameters showing <40% time above MIC 3
• For resistant pneumococcal infections, high-dose amoxicillin (90 mg/kg/day) remains superior 2

Renal Impairment

• For children with creatinine clearance <30 mL/min/1.73 m², reduce dose to 7 mg/kg (up to 300 mg) once daily 1

Administration

• May be given without regard to meals 1
• Suspension remains stable for 10 days after reconstitution when stored at room temperature 1
• Shake well before each dose 1

Tolerability

• Diarrhea is the most common adverse effect, occurring in approximately 20% of children receiving higher doses 3
• The oral suspension has demonstrated superior palatability compared to other oral antimicrobials 4, 5