Cefdinir Dosing for Pediatric Patients
For children aged 6 months through 12 years, cefdinir should be dosed at 7 mg/kg every 12 hours OR 14 mg/kg once daily (maximum 600 mg/day), with the once-daily regimen appropriate for acute otitis media, sinusitis, and pharyngitis/tonsillitis, while twice-daily dosing is required for skin infections. 1
Standard Dosing Regimens
The FDA-approved dosing for pediatric patients provides two equivalent options 1:
- Twice-daily dosing: 7 mg/kg every 12 hours
- Once-daily dosing: 14 mg/kg every 24 hours (total daily dose remains 14 mg/kg for both regimens)
- Maximum daily dose: 600 mg regardless of weight 1
Indication-Specific Considerations
Once-daily dosing (14 mg/kg/day) is effective for 1:
- Acute bacterial otitis media (10 days duration)
- Acute maxillary sinusitis (10 days duration)
- Pharyngitis/tonsillitis (5-10 days duration)
Twice-daily dosing (7 mg/kg every 12 hours) must be used for 1:
- Uncomplicated skin and skin structure infections (10 days duration)
- Once-daily dosing has not been studied for skin infections 1
Weight-Based Practical Dosing
For common pediatric weights using the 250 mg/5 mL suspension 1:
- 9 kg (20 lbs): Use 125 mg/5 mL product
- 18 kg (40 lbs): 2.5 mL every 12 hours OR 5 mL once daily
- 27 kg (60 lbs): 3.75 mL every 12 hours OR 7.5 mL once daily
- 36 kg (80 lbs): 5 mL every 12 hours OR 10 mL once daily
- ≥43 kg (95 lbs): 6 mL every 12 hours OR 12 mL once daily (maximum dose reached) 1
Clinical Context and Positioning
Cefdinir serves as an alternative agent, not first-line therapy, for most pediatric infections. The Infectious Diseases Society of America and Pediatric Infectious Diseases Society position cefdinir alongside cefixime, cefpodoxime, and ceftibuten as alternatives when treating β-lactamase-producing Haemophilus influenzae in community-acquired pneumonia, specifically when amoxicillin-clavulanate cannot be used 2, 3.
Important Limitation
High-dose amoxicillin (90 mg/kg/day) remains superior for resistant pneumococcal infections 3. Research demonstrates that even a higher cefdinir dose of 25 mg/kg once daily achieves pharmacodynamic effectiveness of <40% of the dosing interval against penicillin-nonsusceptible Streptococcus pneumoniae, indicating inadequate coverage for these resistant strains 4. This pharmacokinetic limitation reinforces cefdinir's role as an alternative rather than first-line agent for pneumococcal infections.
Special Populations
For pediatric patients with renal insufficiency (creatinine clearance <30 mL/min/1.73 m²), reduce the dose to 7 mg/kg (up to 300 mg) once daily 1.
For patients on hemodialysis, administer 7 mg/kg every other day, with an additional dose of 7 mg/kg given at the conclusion of each hemodialysis session 1.
Administration and Storage
- May be administered without regard to meals 1
- After reconstitution, suspension remains stable for 10 days at room temperature (25°C/77°F) 1
- Shake well before each administration 1
Safety Profile
Cefdinir demonstrates good tolerability in pediatric populations 5. The most common adverse effect is diarrhea, occurring in approximately 12.5% of patients at standard doses 6, with rates increasing to 20% at higher doses (25 mg/kg) 4. The oral suspension has shown superior palatability compared to other oral antimicrobials, which may improve adherence 5.