Cefdinir Dosing for Pediatric Pneumonia
Direct Answer
For this 5-year-old patient weighing 50 lbs (22.7 kg) with pneumonia, cefdinir is NOT the recommended first-line antibiotic—amoxicillin 90 mg/kg/day (approximately 2000 mg/day divided into two 1000 mg doses) should be used instead. 1, 2 However, if cefdinir must be used (e.g., for β-lactamase-producing Haemophilus influenzae when amoxicillin-clavulanate cannot be given), the dose is 7 mg/kg every 12 hours (approximately 160 mg twice daily) for 10 days. 3
Critical Context: Why Cefdinir Is Not First-Line
Amoxicillin 90 mg/kg/day in 2 divided doses is the definitive first-line treatment for pediatric community-acquired pneumonia, not cefdinir. 2
Cefdinir serves only as an alternative agent when treating β-lactamase-producing Haemophilus influenzae in situations where amoxicillin-clavulanate cannot be used. 4, 1
The Infectious Diseases Society of America and Pediatric Infectious Diseases Society position cefdinir alongside cefixime, cefpodoxime, and ceftibuten as alternatives, not preferred agents. 4
Specific Cefdinir Dosing (If Required)
Standard Pediatric Dosing
7 mg/kg every 12 hours for 10 days is the FDA-approved regimen for pediatric patients aged 6 months through 12 years. 3
For this 22.7 kg (50 lb) patient: 160 mg every 12 hours (total daily dose 320 mg). 3
The once-daily option of 14 mg/kg every 24 hours (approximately 320 mg once daily) is approved for otitis media, sinusitis, and pharyngitis but has not been adequately studied for pneumonia. 3
Evidence Supporting Twice-Daily Dosing for Pneumonia
Twice-daily cefdinir dosing is more effective than once-daily dosing against common bacterial respiratory pathogens in producing bacterial killing and preventing regrowth. 5
Twice-daily administration is the more appropriate cefdinir dosing strategy specifically for community-acquired pneumonia treatment. 5
Why This Matters Clinically
Resistance and Coverage Concerns
High-dose amoxicillin (90 mg/kg/day) remains superior for resistant pneumococcal infections, which are the most common cause of bacterial pneumonia in children. 1, 2
Underdosing amoxicillin (using 40-45 mg/kg/day instead of 90 mg/kg/day) is a common and dangerous error that leads to treatment failure. 2
Cefdinir has good activity against β-lactamase-producing H. influenzae but is not optimal for Streptococcus pneumoniae, the primary pathogen. 6
When Cefdinir Is Appropriate
For children not fully immunized against Haemophilus influenzae type b or Streptococcus pneumoniae, where β-lactamase-producing organisms are suspected. 2
When amoxicillin-clavulanate cannot be used due to intolerance or allergy (though other alternatives like cefpodoxime or cefuroxime may be preferred). 4
Practical Administration
Cefdinir may be administered without regard to meals. 3
Using the 250 mg/5 mL suspension: Give 3.2 mL (160 mg) every 12 hours. 3
The suspension can be stored at room temperature and must be discarded after 10 days. 3
Critical Pitfalls to Avoid
Do not use cefdinir as first-line therapy for presumed pneumococcal pneumonia—this represents inappropriate antibiotic selection. 2
Do not use once-daily dosing for pneumonia—it has not been studied for this indication and is less effective. 3, 5
Reassess the patient at 48-72 hours—if no clinical improvement occurs, consider treatment failure and need for broader coverage or hospitalization. 2
Consider adding azithromycin (10 mg/kg day 1, then 5 mg/kg days 2-5) if atypical pathogens (Mycoplasma or Chlamydophila) are suspected in this 5-year-old. 2