What is the recommended use and dosage of Cefdinir (Cefdinir) for treating bacterial infections?

Cefdinir: Recommended Use and Dosage for Bacterial Infections

Overview and Spectrum of Activity

Cefdinir is an oral third-generation cephalosporin with broad-spectrum activity against common respiratory and skin pathogens, including Streptococcus pneumoniae (penicillin-susceptible strains), Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus (methicillin-susceptible), and Streptococcus pyogenes. 1

• Cefdinir demonstrates stability against 13 common beta-lactamases, making it effective against beta-lactamase-producing strains of H. influenzae and M. catarrhalis 2, 3
• The drug has no activity against methicillin-resistant S. aureus (MRSA), Pseudomonas species, Enterococcus species, or penicillin-resistant streptococci 1
• Beta-lactamase negative, ampicillin-resistant (BLNAR) H. influenzae strains are typically non-susceptible to cefdinir 1

FDA-Approved Indications and Dosing

Pediatric Patients (6 Months Through 12 Years)

The total daily dose for all pediatric infections is 14 mg/kg, up to a maximum of 600 mg per day, administered either once daily or divided into twice-daily dosing. 1

Specific Pediatric Dosing by Indication:

• Acute Bacterial Otitis Media: 7 mg/kg every 12 hours OR 14 mg/kg every 24 hours for 5-10 days 1
• Acute Maxillary Sinusitis: 7 mg/kg every 12 hours OR 14 mg/kg every 24 hours for 10 days 1
• Pharyngitis/Tonsillitis: 7 mg/kg every 12 hours OR 14 mg/kg every 24 hours for 5-10 days 1
• Uncomplicated Skin and Skin Structure Infections: 7 mg/kg every 12 hours for 10 days (once-daily dosing has NOT been studied for skin infections) 1

Adult and Adolescent Dosing

Adults and adolescents should receive 300 mg twice daily or 600 mg once daily, depending on the indication. 4, 3

• Community-Acquired Pneumonia: 300 mg twice daily for 10 days 4
• Acute Bacterial Exacerbation of Chronic Bronchitis: 300 mg twice daily for 5-10 days 4
• Acute Maxillary Sinusitis: 300 mg twice daily or 600 mg once daily for 10 days 4
• Pharyngitis/Tonsillitis: 300 mg twice daily or 600 mg once daily for 5-10 days 4
• Uncomplicated Skin and Skin Structure Infections: 300 mg twice daily for 10 days 4

Guideline-Based Recommendations

Community-Acquired Pneumonia in Children

For pediatric community-acquired pneumonia, cefdinir is listed as an alternative oral agent for step-down therapy or mild infections caused by specific pathogens. 5

• For H. influenzae (beta-lactamase producing): Cefdinir is an alternative to amoxicillin-clavulanate, along with cefixime, cefpodoxime, or ceftibuten 5
• For S. pneumoniae with penicillin MICs <2.0 µg/mL: Second- or third-generation cephalosporins (including cefdinir) are alternatives to amoxicillin 5

Community-Acquired Pneumonia in Adults

In adults with CAP, cefdinir is an alternative oral cephalosporin for S. pneumoniae infections when directed therapy is appropriate. 5

• Oral cephalosporins listed include cefpodoxime, cefprozil, cefuroxime, cefdinir, and cefditoren as alternatives to penicillin or amoxicillin 5

Acute Bacterial Rhinosinusitis

Cefdinir is recommended as an alternative agent for patients with penicillin intolerance (non-Type I hypersensitivity) or for those at risk for resistant pathogens. 5

• Cefdinir has activity against S. pneumoniae comparable to second-generation agents (cefuroxime axetil, cefpodoxime proxetil) 5
• Its activity against H. influenzae is similar to cefuroxime axetil but lower than cefpodoxime proxetil 5
• For children with moderate disease or recent antibiotic use, cefdinir is preferred over cefpodoxime based on superior patient acceptance of the suspension formulation 5

Special Populations and Dosage Adjustments

Renal Insufficiency

For patients with creatinine clearance <30 mL/min, reduce the dose to 300 mg once daily (or 7 mg/kg once daily in pediatric patients). 1

Hemodialysis Patients

Administer 300 mg (or 7 mg/kg) every other day, with an additional dose at the conclusion of each hemodialysis session. 1

• Hemodialysis removes 63% of cefdinir from the body and reduces elimination half-life from 16 hours to 3.2 hours 1

Geriatric Patients

No dosage adjustment is required for elderly patients unless creatinine clearance is <30 mL/min. 1

• Systemic exposure increases in older subjects (Cmax by 44%, AUC by 86%) due to reduced renal clearance, but this is related to renal function rather than age per se 1

Administration Guidelines

Timing and Food Interactions

• Cefdinir may be administered without regard to meals 1
• Critical drug interaction: Take cefdinir at least 2-3 hours before or after aluminum-containing antacids, multivitamins, or mineral supplements containing aluminum, calcium, iron, or magnesium 6
• Separating doses by only 1 hour is insufficient; the minimum separation must be 2-3 hours 6

Suspension Preparation

• After mixing, the suspension can be stored at room temperature (25°C/77°F) for 10 days 1
• Shake well before each administration 1

Alternative Agents for Cefdinir-Allergic Patients

For patients with cefdinir allergy, treatment options depend on the type of hypersensitivity reaction and the infection being treated. 7

For Impetigo or Skin Infections:

• Non-anaphylactic penicillin allergy: First-generation cephalosporins may be used 7
• Anaphylactic penicillin allergy: Use clindamycin, macrolides, or sulfamethoxazole-trimethoprim (avoid all beta-lactams) 7
• Topical therapy: Mupirocin 2% or retapamulin 1% for limited lesions 7

Common Pitfalls and Caveats

Resistance Considerations

• Cefdinir has NO clinically significant activity against drug-resistant S. pneumoniae (DRSP) with penicillin MICs ≥4.0 µg/mL 5
• Cefdinir is inactive against MRSA, despite some clinical studies showing response rates in MRSA infections (likely due to incision and drainage rather than antibiotic effect) 8
• BLNAR H. influenzae strains are typically non-susceptible 1

Adverse Effects

• Diarrhea is the most common adverse event (10% in adults), occurring more frequently than with some comparators like cephalexin (4%) 8
• The suspension formulation is very well accepted among children with superior taste compared to other oral antimicrobials 4, 3

Clinical Decision-Making

• For acute bacterial rhinosinusitis in children with recent antibiotic use or moderate disease, high-dose amoxicillin-clavulanate (90 mg/kg/day) is preferred over cefdinir 5
• Cefpodoxime proxetil is often regarded as the preferred cephalosporin for treatment failures with high-dose amoxicillin or amoxicillin-clavulanate due to greater activity against H. influenzae, though poor taste limits pediatric use 5
• Once-daily dosing has NOT been studied for skin infections; therefore, twice-daily dosing should be used for these indications 1