Cefdinir Dosing for Bacterial Infections
Cefdinir is dosed at 14 mg/kg/day (maximum 600 mg/day) in pediatric patients aged 6 months through 12 years, administered either as 7 mg/kg every 12 hours or 14 mg/kg once daily, depending on the infection type. 1
Pediatric Dosing (6 Months Through 12 Years)
The total daily dose is 14 mg/kg/day, up to a maximum of 600 mg per day, with dosing frequency varying by infection type 1:
Infection-Specific Regimens
- 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 (once-daily dosing has NOT been studied for skin infections) 1
Weight-Based Dosing Chart
For practical administration using the 125 mg/5 mL or 250 mg/5 mL suspension 1:
- 9 kg (20 lbs): 2.5 mL every 12 hours OR 5 mL once daily
- 18 kg (40 lbs): 5 mL every 12 hours OR 10 mL once daily (125 mg/5 mL product)
- 27 kg (60 lbs): 7.5 mL every 12 hours OR 15 mL once daily (125 mg/5 mL product)
- 36 kg (80 lbs): 10 mL every 12 hours OR 20 mL once daily (125 mg/5 mL product)
- ≥43 kg (95 lbs): Maximum dose of 600 mg/day applies
Adult and Adolescent Dosing
300 mg every 12 hours OR 600 mg once daily for 5-10 days, depending on the infection 1, 2. Once-daily dosing (600 mg) has been shown to be as effective as twice-daily dosing (300 mg BID) for 10 days in clinical trials 1.
Renal Impairment Adjustments
Critical dosing modifications are required for patients with renal insufficiency 1:
Adults with Creatinine Clearance <30 mL/min
- 300 mg once daily 1
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
- Post-dialysis supplementation: 300 mg (or 7 mg/kg) at the conclusion of each hemodialysis session 1
- Maintenance: 300 mg (or 7 mg/kg) every other day thereafter 1
The rationale for this adjustment is that hemodialysis removes 63% of cefdinir from the body and reduces the elimination half-life from 16 hours to 3.2 hours 1.
Administration Considerations
Cefdinir may be administered without regard to meals, providing flexibility in dosing schedules 1. The oral suspension maintains stability for 10 days at room temperature (25°C/77°F) after reconstitution, after which any unused portion must be discarded 1.
Suspension Preparation
Tap the bottle to loosen powder, then add water in two portions, shaking well after each addition 1. The container should be kept tightly closed and shaken well before each administration 1.
Clinical Efficacy Context
Cefdinir demonstrates excellent activity against common respiratory and skin pathogens, including penicillin-susceptible Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, methicillin-susceptible Staphylococcus aureus, and Streptococcus pyogenes 1. The drug is stable against many β-lactamases, making it effective against β-lactamase-producing strains of H. influenzae and M. catarrhalis 3, 4.
Important limitation: Cefdinir is inactive against β-lactamase negative, ampicillin-resistant (BLNAR) H. influenzae strains, which are typically non-susceptible 1.
Common Pitfalls
- Do not use once-daily dosing for skin infections in pediatric patients—only twice-daily dosing has been studied for this indication 1
- Patients weighing ≥43 kg should receive the maximum daily dose of 600 mg, not weight-based dosing that would exceed this limit 1
- Diarrhea is the most common adverse event and occurs more frequently than with some comparators, though discontinuation rates are generally similar 3
- Elderly patients do not require dosage adjustment based on age alone—only adjust for creatinine clearance <30 mL/min 1