What is the dosage and treatment protocol for Cefdinir (Cefdinir) for bacterial infections?

Cefdinir Dosing and Treatment Protocol for Bacterial Infections

Standard Dosing Regimens

Cefdinir is dosed at 300 mg twice daily or 600 mg once daily in adults and adolescents, or 14 mg/kg/day (maximum 600 mg/day) in one or two divided doses in pediatric patients aged 6 months and older, with treatment duration typically 5-10 days depending on the infection type. 1

Adult and Adolescent Dosing

• Standard dose: 300 mg every 12 hours OR 600 mg once daily 1, 2
• Maximum daily dose: 600 mg 1
• Administration: Can be taken without regard to meals 1

Pediatric Dosing (Age 6 Months Through 12 Years)

• Total daily dose: 14 mg/kg, up to maximum 600 mg/day 1
• Dosing options: 7 mg/kg every 12 hours OR 14 mg/kg once daily 1
• Weight-based dosing examples:
  • 9 kg (20 lbs): 2.5 mL of 125 mg/5 mL suspension every 12 hours or 5 mL once daily 1
  • 18 kg (40 lbs): 5 mL of 125 mg/5 mL suspension every 12 hours or 10 mL once daily 1
  • ≥43 kg (95 lbs): Maximum dose of 600 mg/day 1

Infection-Specific Treatment Durations

Respiratory Tract Infections

• Acute bacterial otitis media: 5-10 days (once-daily dosing) or 10 days (twice-daily dosing) 1
• Acute maxillary sinusitis: 10 days 1
• Pharyngitis/tonsillitis: 5-10 days (once-daily dosing) or 10 days (twice-daily dosing) 1
• Community-acquired pneumonia: 10 days 2, 3
• Acute bacterial exacerbation of chronic bronchitis: 5-10 days 2, 4

Skin and Soft Tissue Infections

• Uncomplicated skin and skin structure infections: 10 days with twice-daily dosing 1
• Important caveat: Once-daily dosing has NOT been studied for skin infections; therefore, cefdinir must be administered twice daily for these infections 1

Special Population Dosing Adjustments

Renal Insufficiency

• Adults with CrCl <30 mL/min: 300 mg once daily 1
• Pediatric patients with CrCl <30 mL/min/1.73 m²: 7 mg/kg (up to 300 mg) once daily 1

Hemodialysis Patients

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

Clinical Indications and Pathogen Coverage

Approved Indications

Cefdinir is FDA-approved for treatment of the following bacterial infections 1, 2:

• Community-acquired pneumonia
• Acute bacterial exacerbations of chronic bronchitis
• Acute maxillary sinusitis
• Pharyngitis/tonsillitis
• Acute bacterial otitis media
• Uncomplicated skin and skin structure infections

Pathogen Coverage

Cefdinir demonstrates excellent activity against 2, 3, 4:

• Streptococcus pneumoniae (penicillin-susceptible strains)
• Haemophilus influenzae (including β-lactamase-producing strains)
• Moraxella catarrhalis (including β-lactamase-producing strains)
• Streptococcus pyogenes (Group A Streptococcus)
• Staphylococcus aureus (methicillin-susceptible)

Cefdinir is stable to hydrolysis by 13 common β-lactamases, making it particularly useful in areas with elevated rates of β-lactamase production 3, 4

Role in Guideline-Directed Therapy

Community-Acquired Pneumonia

For penicillin-susceptible S. pneumoniae (MIC <2.0 µg/mL), cefdinir is listed as an alternative oral agent alongside other second- or third-generation cephalosporins (cefpodoxime, cefuroxime, cefprozil) for step-down therapy or mild infection 5

Acute Bacterial Sinusitis

Cefdinir is recognized as a suitable third-generation cephalosporin for bacterial sinusitis, with enhanced activity against β-lactamase-producing H. influenzae and M. catarrhalis 6

Important Clinical Considerations and Pitfalls

When Cefdinir May NOT Be Appropriate

• Penicillin-resistant S. pneumoniae (MIC ≥4.0 µg/mL): Guidelines recommend levofloxacin, linezolid, or high-dose amoxicillin instead 5
• Methicillin-resistant S. aureus: Requires vancomycin, linezolid, or other MRSA-active agents 5
• Severe or complicated infections: May require parenteral therapy initially 5
• Necrotizing infections: Require broader coverage and surgical intervention 5

Treatment Failure Management

If phlegmonous tonsillitis or other infections do not respond to cefdinir after 72 hours, switch to high-dose amoxicillin-clavulanate (90 mg/6.4 mg per kg per day in children or 4 g/250 mg per day in adults) or consider parenteral ceftriaxone therapy 7

Allergy Considerations

For patients with cefdinir allergy requiring treatment for impetigo or other skin infections, alternatives include topical mupirocin or retapamulin for limited lesions, or oral clindamycin or sulfamethoxazole-trimethoprim for extensive disease 8

Adverse Effects

• Most common: Diarrhea (occurs in approximately 20% of patients) 9
• Generally well-tolerated: Discontinuation rates due to adverse events are similar to comparator agents 4, 9
• Pediatric advantage: Superior taste and palatability compared to other oral antimicrobials 2, 4

Suspension Preparation and Storage

After mixing, cefdinir suspension can be stored at room temperature (25°C/77°F) in a tightly closed container for 10 days, after which any unused portion must be discarded 1