What is the recommended dosage of cefdinir (Cefdinir) for an 18 kg pediatric patient with otitis media?

Cefdinir Dosing for Otitis Media in an 18 kg Pediatric Patient

For an 18 kg child with otitis media, administer cefdinir 14 mg/kg/day (252 mg total daily dose), which can be given either as 7 mg/kg (126 mg) every 12 hours OR as a single daily dose of 14 mg/kg (252 mg) for 5-10 days. 1, 2

Practical Dosing Using Available Formulations

Using the FDA-approved suspension formulations 2:

• 125 mg/5 mL suspension: Give 5 mL every 12 hours OR 10 mL once daily 2
• 250 mg/5 mL suspension: Give 2.5 mL every 12 hours OR 5 mL once daily 2

Duration of Therapy

• Standard duration: 5-10 days for acute otitis media 1, 2
• The once-daily dosing regimen for 10 days has been shown to be as effective as twice-daily dosing 2
• Once-daily dosing has superior patient acceptance due to improved palatability and convenience 3, 1

Clinical Positioning and When to Use Cefdinir

Cefdinir is recommended as an alternative agent rather than first-line therapy 1:

• First-line treatment remains high-dose amoxicillin (80-90 mg/kg/day) for most children with acute otitis media 1
• Use cefdinir when:
  • Non-anaphylactic penicillin allergy is present 3, 1
  • Recent antibiotic use within the previous 4-6 weeks 3, 1
  • Patient acceptance/palatability is a concern (cefdinir is preferred over other cephalosporins for taste) 3, 1

Important Caveats and Limitations

Critical limitation regarding resistant organisms: Research demonstrates that the standard 14 mg/kg/day dose has significantly reduced efficacy against penicillin-nonsusceptible Streptococcus pneumoniae 4, 5:

• Eradication rates for penicillin-susceptible S. pneumoniae: 91% 4
• Eradication rates for penicillin-intermediate S. pneumoniae: 67% 4
• Eradication rates for penicillin-resistant S. pneumoniae: only 43% 4

Higher doses (25 mg/kg/day) have been studied but are NOT recommended because pharmacokinetic studies show they remain ineffective against penicillin-nonsusceptible strains and cause significantly more diarrhea (20% incidence) 5.

Comparative effectiveness data: A head-to-head trial found that high-dose amoxicillin/clavulanate (10 days) achieved an 86.5% cure rate compared to only 71% for cefdinir (5 days), with cefdinir showing decreasing effectiveness as children increased in age 6.

Administration Details

• May be administered without regard to meals 2
• Shake suspension well before each dose 2
• Store at room temperature after reconstitution 2
• Discard unused suspension after 10 days 2

Special Populations

If this patient has renal insufficiency (creatinine clearance <30 mL/min/1.73 m²), reduce the dose to 7 mg/kg once daily (up to 300 mg maximum) 2.