What is the recommended dosage of cefdinir (Cefdinir) for treating otitis media in a child?

How to Prescribe Cefdinir for Otitis Media in a Child

For pediatric acute otitis media, prescribe cefdinir at 14 mg/kg/day, given either as a single daily dose (14 mg/kg once daily) or divided into two doses (7 mg/kg every 12 hours) for 5-10 days. 1, 2

When to Use Cefdinir

Cefdinir is not first-line therapy for acute otitis media. Use it specifically in these situations:

• Penicillin allergy (non-anaphylactic reactions) 1, 3
• Recent antibiotic exposure (amoxicillin use within the previous 30 days) 3
• First-line treatment failure after 48-72 hours of high-dose amoxicillin 1

The American Academy of Pediatrics guidelines clearly state that high-dose amoxicillin (80-90 mg/kg/day) remains the first-line treatment for most children with acute otitis media. 1

Specific Dosing Instructions

Standard Dosing

• Total daily dose: 14 mg/kg/day (maximum 600 mg/day) 1, 2
• Frequency options:
  • Once daily: 14 mg/kg every 24 hours 1, 2
  • Twice daily: 7 mg/kg every 12 hours 1, 2
• Duration: 5-10 days 1, 2

Practical Dosing by Weight (using oral suspension)

For 125 mg/5 mL suspension: 2

• 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
• 27 kg (60 lbs): 7.5 mL every 12 hours OR 15 mL once daily
• 36 kg (80 lbs): 10 mL every 12 hours OR 20 mL once daily

For 250 mg/5 mL suspension: 2

• 18 kg (40 lbs): 2.5 mL every 12 hours OR 5 mL once daily
• 27 kg (60 lbs): 3.75 mL every 12 hours OR 7.5 mL once daily
• ≥43 kg (95 lbs): 6 mL every 12 hours OR 12 mL once daily (maximum dose)

Administration Details

• Can be given with or without food 2
• Once-daily dosing is as effective as twice-daily dosing for otitis media 2, 4
• Suspension stability: After mixing, store at room temperature; discard after 10 days 2
• Shake well before each dose 2

Important Clinical Considerations

Efficacy Limitations

Cefdinir is less effective than high-dose amoxicillin-clavulanate for acute otitis media. A head-to-head comparison showed amoxicillin-clavulanate achieved 86.5% clinical cure versus 71.0% for cefdinir (p=0.001). 5 Additionally, cefdinir's efficacy decreases as children get older (6-24 months age range), suggesting weight-based dosing may be inadequate in larger children. 5

The current 14 mg/kg dose provides inadequate coverage against penicillin-nonsusceptible Streptococcus pneumoniae. 6 Even a higher 25 mg/kg dose was shown to be ineffective against these resistant strains. 6

Cross-Reactivity with Penicillin Allergy

Cefdinir has negligible cross-reactivity with penicillin due to its distinct chemical structure as a third-generation cephalosporin. 1 The historical 10% cross-reactivity rate is an overestimate; actual risk is approximately 0.1% in patients without severe/recent penicillin reactions. 1

When to Reassess

• Evaluate clinical response at 48-72 hours 1
• If no improvement or worsening symptoms, consider:
  • Switching to high-dose amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component) 1
  • Intramuscular ceftriaxone (50 mg/kg for 1-3 days) 1

Common Pitfalls to Avoid

• Do not use cefdinir as first-line therapy when amoxicillin is appropriate 1, 3
• Do not prescribe cefdinir for treatment failures if the child already received it or another cephalosporin—switch to amoxicillin-clavulanate or ceftriaxone instead 1
• Do not assume 5-day courses are always adequate—10-day courses may be necessary for complete resolution, particularly in younger children or those with bilateral disease 1, 2
• Diarrhea occurs in approximately 8-20% of patients on cefdinir, which may affect compliance 5, 6

Special Populations

Renal Insufficiency

For children with creatinine clearance <30 mL/min/1.73 m²: 2

• Reduce dose to 7 mg/kg once daily (maximum 300 mg)

Hemodialysis

• 7 mg/kg every other day 2
• Give an additional dose (7 mg/kg) after each dialysis session 2