What is the dosing for cefdinir (Cephalosporin antibiotic)?

Cefdinir Dosing

Cefdinir is dosed at 14 mg/kg/day (maximum 600 mg/day) in pediatric patients aged 6 months through 12 years, administered either as 7 mg/kg every 12 hours or 14 mg/kg once daily, and 300 mg twice daily or 600 mg once daily in adults and adolescents, with treatment duration typically 5-10 days depending on the infection type. 1

Pediatric Dosing (6 Months Through 12 Years)

Standard Dosing:

• Total daily dose: 14 mg/kg/day (maximum 600 mg/day) 1
• Can be administered as:
  • 7 mg/kg every 12 hours, OR 1
  • 14 mg/kg once daily 1

Duration by Infection Type:

• Acute bacterial otitis media: 5-10 days (once daily) or 10 days (twice daily) 1
• Acute maxillary sinusitis: 10 days 1
• Pharyngitis/tonsillitis: 5-10 days (once daily) or 10 days (twice daily) 1
• Uncomplicated skin and skin structure infections: 10 days (twice daily only—once-daily dosing not studied for skin infections) 1

Weight-Based Dosing Chart (125 mg/5 mL suspension):

• 9 kg (20 lbs): 2.5 mL every 12 hours or 5 mL once daily 1
• 18 kg (40 lbs): 5 mL every 12 hours or 10 mL once daily 1
• 27 kg (60 lbs): 7.5 mL every 12 hours or 15 mL once daily 1
• 36 kg (80 lbs): 10 mL every 12 hours or 20 mL once daily 1
• ≥43 kg (95 lbs): 12 mL every 12 hours or 24 mL once daily 1

Adult and Adolescent Dosing

Standard Dosing:

• 300 mg twice daily, OR 1, 2
• 600 mg once daily 1, 2
• Treatment duration: 5-10 days depending on infection type 1, 2

Infection-Specific Guidance:

• Cefdinir is listed as an alternative oral agent for beta-lactamase producing Haemophilus influenzae infections in community-acquired pneumonia 3
• Effective for acute bacterial exacerbations of chronic bronchitis, community-acquired pneumonia, acute maxillary sinusitis, pharyngitis/tonsillitis, and uncomplicated skin infections 2, 4

Renal Dosing Adjustments

Adults with Creatinine Clearance <30 mL/min:

• 300 mg once daily 1

Pediatric Patients with Creatinine Clearance <30 mL/min/1.73 m²:

• 7 mg/kg (maximum 300 mg) once daily 1

Hemodialysis Patients:

• Initial dose: 300 mg (or 7 mg/kg) every other day 1
• At conclusion of each hemodialysis session: Give 300 mg (or 7 mg/kg) 1
• Subsequent doses: 300 mg (or 7 mg/kg) every other day 1

Administration Considerations

Food Effects:

• May be administered without regard to meals 1

Suspension Preparation:

• After mixing, suspension can be stored at room temperature (25°C/77°F) 1
• Container should be kept tightly closed and shaken well before each administration 1
• Suspension may be used for 10 days, after which any unused portion must be discarded 1

Palatability:

• Cefdinir oral suspension has demonstrated superior taste and palatability compared to other oral antimicrobial agents, which may improve adherence in pediatric patients 2, 4

Clinical Efficacy Context

Spectrum of Activity:

• Good activity against Streptococcus pneumoniae (penicillin-susceptible), Haemophilus influenzae, and Moraxella catarrhalis 2, 4
• Stable to hydrolysis by commonly occurring plasmid-mediated beta-lactamases 4
• Retains activity against beta-lactamase-producing strains of H. influenzae and M. catarrhalis 4

Pharmacokinetics:

• Peak plasma concentration occurs approximately 3 hours after oral administration 5
• Terminal half-life approximately 1.5 hours 5
• Distributes well into respiratory tract tissues, fluids, sinus tissue, tonsil tissue, middle ear fluid, and skin blisters 2, 4

Common Pitfalls

Skin Infection Dosing:

• Once-daily dosing has NOT been studied for skin infections; therefore, cefdinir must be administered twice daily (7 mg/kg every 12 hours) for uncomplicated skin and skin structure infections 1

Diarrhea:

• Diarrhea is the most common adverse event, occurring in approximately 20% of patients 6
• While incidence may be higher than some comparators, discontinuation rates due to adverse events are generally similar 4