From the Guidelines
Cefdinir is not the first-line treatment for cellulitis in a burn patient, as it does not provide adequate coverage against methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas, which are common pathogens in burn wounds. According to the guidelines by the Infectious Diseases Society of America 1, empirical therapy for MRSA should be considered pending culture data in hospitalized patients with complicated skin and soft tissue infections (cSSTI), including those with burns. The recommended options for empirical therapy include intravenous vancomycin, linezolid, daptomycin, telavancin, and clindamycin.
For outpatients with nonpurulent cellulitis, empirical therapy for infection due to beta-hemolytic streptococci is recommended, and cefdinir may be considered as an option due to its effectiveness against Streptococcus species 1. However, in burn patients, the risk of resistant organisms is higher, and culture results should guide therapy. The typical adult dosage of cefdinir is 300 mg twice daily or 600 mg once daily for 7-14 days, depending on infection severity.
It's essential to note that cefdinir is a third-generation cephalosporin with good oral bioavailability, making it convenient for patients who don't require intravenous therapy. However, for severe burn-related cellulitis, initial intravenous antibiotics may be more appropriate, with cefdinir potentially used for step-down therapy. The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period 1.
In summary, while cefdinir may be used for cellulitis in a burn patient, it is not the first-line treatment due to its limited coverage against MRSA and Pseudomonas. Culture results and the severity of the infection should guide the choice of antibiotic therapy.
From the FDA Drug Label
Uncomplicated Skin and Skin Structure Infections caused by Staphylococcus aureus (including β-lactamase producing strains) and Streptococcus pyogenes Cefdinir may be used for cellulitis in a burn patient because it is indicated for the treatment of uncomplicated skin and skin structure infections caused by Staphylococcus aureus and Streptococcus pyogenes, which are common pathogens in burn patients.
- The use of cefdinir in this context would be based on its in vitro activity against these bacteria.
- However, it is essential to note that cefdinir should only be used when the infection is proven or strongly suspected to be caused by susceptible bacteria 2.
From the Research
Use of Cefdinir for Cellulitis in Burn Patients
- Cefdinir is an oral third-generation cephalosporin with good in vitro activity against many pathogens commonly causative in community-acquired infections, including those that can cause cellulitis 3, 4, 5.
- It has been shown to be effective in the treatment of uncomplicated skin and skin structure infections, including cellulitis, in adults and pediatric patients 6, 7.
- Cefdinir has a broad spectrum of activity against many gram-negative and gram-positive aerobic organisms, including Staphylococcus aureus and Streptococcus pyogenes, which are common causes of skin infections 5.
- In a study comparing cefdinir to cephalexin for the treatment of mild to moderate uncomplicated skin and skin structure infections, cefdinir was found to be as effective as cephalexin in achieving clinical cure, with a cure rate of 89% 7.
- Cefdinir is usually well tolerated, with the most common adverse events being diarrhea, nausea, and vaginal mycosis 3, 7.
Mechanism of Action and Pharmacokinetics
- Cefdinir is stable to hydrolysis by commonly occurring plasmid-mediated beta-lactamases and retains good activity against beta-lactamase-producing strains of Haemophilus influenzae and Moraxella catarrhalis 3.
- It distributes well into various tissues and fluids, including skin blisters and ear fluids, and has a pharmacokinetic profile that allows for once- or twice-daily administration 4, 5.
- Cefdinir is rapidly absorbed from the gastrointestinal tract and is almost entirely eliminated via renal clearance of unchanged drug, with a terminal disposition half-life of approximately 1.5 hours 5.
Clinical Use in Burn Patients
- While there is no specific study mentioned in the provided evidence that directly addresses the use of cefdinir in burn patients, its effectiveness in treating uncomplicated skin and skin structure infections, including cellulitis, makes it a potential option for use in burn patients with cellulitis 3, 4, 5, 6, 7.