From the FDA Drug Label
Patients With Renal Insufficiency For adult patients with creatinine clearance <30 mL/min, the dose of cefdinir should be 300 mg given once daily. In patients maintained on chronic hemodialysis, the recommended initial dosage regimen is a 300 mg or 7 mg/kg dose every other day. For pediatric patients with a creatinine clearance of <30 mL/min/1. 73 m2, the dose of cefdinir should be 7 mg/kg (up to 300 mg) given once daily.
The dose of cefdinir in patients with End-Stage Renal Disease (ESRD) is 300 mg given once daily for adults, and 7 mg/kg (up to 300 mg) given once daily for pediatric patients. For patients on hemodialysis, the recommended dose is 300 mg or 7 mg/kg every other day, with an additional dose given at the conclusion of each hemodialysis session 1.
From the Research
For patients with end-stage renal disease (ESRD), the recommended cefdinir dosage is 300 mg once daily or 7 mg/kg once daily for pediatric patients, which is a 50% reduction from the standard dose used in patients with normal renal function, as supported by general medical knowledge and dosing guidelines for renal impairment 2, 3. The dosage reduction is necessary because impaired renal function leads to decreased drug clearance and potential accumulation of the medication, which could increase the risk of adverse effects such as nausea, diarrhea, and headache.
- Key considerations for cefdinir dosing in ESRD patients include:
- Administering the dose after dialysis sessions for patients on hemodialysis, as cefdinir is partially removed during hemodialysis 4
- Monitoring patients for clinical response and signs of toxicity
- Maintaining the frequency of once daily for severe infections, rather than increasing the individual dose, to avoid drug accumulation while maintaining therapeutic efficacy It's also important to note that nonrenal clearance pathways may be altered in patients with ESRD, which can impact drug metabolism and transport 5, 6. However, the specific effects of these changes on cefdinir dosing are not well established, and therefore, the recommended dosage is based on general guidelines for renal impairment.