What is the recommended dose of cefdinir (Omnicef) for adults and children?

Cefdinir Dosing Recommendations

Cefdinir is dosed at 300 mg twice daily or 600 mg once daily for adults, and 14 mg/kg/day (maximum 600 mg/day) in one or two divided doses for pediatric patients aged 6 months through 12 years, with dosing adjustments required for renal insufficiency. 1

Adult Dosing

• Standard adult dose: 300 mg orally twice daily OR 600 mg orally once daily for 5-10 days depending on the infection type 1, 2
• The twice-daily regimen (300 mg BID) and once-daily regimen (600 mg QD) have demonstrated equivalent clinical and bacteriological efficacy in controlled trials 2, 3
• Cefdinir may be administered without regard to meals, though administration with food may improve gastrointestinal tolerability 1

Pediatric Dosing (6 Months Through 12 Years)

Total daily dose: 14 mg/kg/day (maximum 600 mg/day) administered as either: 1

• 7 mg/kg every 12 hours (twice daily), OR
• 14 mg/kg every 24 hours (once daily)

Infection-Specific Pediatric Dosing

• Acute bacterial otitis media: 7 mg/kg q12h for 5-10 days OR 14 mg/kg q24h for 10 days 1
• Acute maxillary sinusitis: 7 mg/kg q12h for 10 days OR 14 mg/kg q24h for 10 days 1
• Pharyngitis/tonsillitis: 7 mg/kg q12h for 5-10 days OR 14 mg/kg q24h for 10 days 1
• Uncomplicated skin and skin structure infections: 7 mg/kg q12h for 10 days (once-daily dosing has NOT been studied for skin infections) 1

Weight-Based Pediatric Dosing Chart

For 125 mg/5 mL suspension: 1

• 9 kg (20 lbs): 2.5 mL q12h or 5 mL q24h
• 18 kg (40 lbs): 5 mL q12h or 10 mL q24h
• 27 kg (60 lbs): 7.5 mL q12h or 15 mL q24h
• 36 kg (80 lbs): 10 mL q12h or 20 mL q24h
• ≥43 kg (95 lbs): 12 mL q12h or 24 mL q24h (maximum daily dose 600 mg)

Renal Insufficiency Dosing

For creatinine clearance <30 mL/min: 1

• Adults: 300 mg orally once daily
• Pediatric patients: 7 mg/kg (maximum 300 mg) orally once daily

Hemodialysis Dosing

• Initial dose: 300 mg (adults) or 7 mg/kg (pediatric) every other day 1
• Post-dialysis supplementation: 300 mg (adults) or 7 mg/kg (pediatric) at the conclusion of each hemodialysis session 1
• Maintenance: Continue 300 mg or 7 mg/kg every other day between dialysis sessions 1

Clinical Context and Spectrum of Activity

Cefdinir provides excellent coverage against common respiratory and skin pathogens, including Streptococcus pneumoniae (penicillin-susceptible), Haemophilus influenzae (including β-lactamase-producing strains), and Moraxella catarrhalis 4, 2, 3. The drug is stable to hydrolysis by commonly occurring plasmid-mediated β-lactamases, making it particularly useful in areas with elevated rates of β-lactamase production 2, 3.

Important Caveats

• Skin infections in children require twice-daily dosing because once-daily regimens have not been adequately studied for this indication 1
• Diarrhea is the most common adverse effect, occurring in approximately 20% of patients, though it is typically mild 3, 5
• The oral suspension has demonstrated superior taste and palatability compared to other oral antimicrobials, which may improve adherence in pediatric patients 2, 3
• After reconstitution, the suspension remains stable at room temperature (25°C/77°F) for 10 days when kept tightly closed; shake well before each use 1