Cefdinir Dosing for Impetigo in Pediatric Patients
For impetigo in children, administer cefdinir 7 mg/kg every 12 hours (twice daily) for 10 days, up to a maximum total daily dose of 600 mg. 1
Dosing Specifics
The FDA-approved dosing for uncomplicated skin and skin structure infections (including impetigo) in pediatric patients aged 6 months through 12 years is:
- 7 mg/kg every 12 hours for 10 days 1
- Maximum daily dose: 600 mg (for children ≥43 kg) 1
- Once-daily dosing has NOT been studied for skin infections and should not be used 1
Weight-Based Dosing Chart (using 125 mg/5 mL suspension)
- 9 kg (20 lbs): 2.5 mL every 12 hours 1
- 18 kg (40 lbs): 5 mL every 12 hours 1
- 27 kg (60 lbs): 7.5 mL every 12 hours 1
- 36 kg (80 lbs): 10 mL every 12 hours 1
- ≥43 kg (95 lbs): 12 mL every 12 hours 1
Clinical Context and Evidence
While cefdinir is FDA-approved for skin infections, it is NOT the first-line agent for impetigo. 2 The American Academy of Pediatrics recommends topical mupirocin 2% ointment three times daily for 5 days as first-line therapy for localized impetigo, as it is equally or more effective than oral antibiotics with fewer side effects. 2
When oral antibiotics are indicated (extensive disease, multiple lesions, or failed topical therapy), cephalexin 25-50 mg/kg/day divided into 3-4 doses for 7 days is the preferred oral agent, not cefdinir. 2 Cephalexin provides excellent coverage against both Staphylococcus aureus and Streptococcus pyogenes, the primary pathogens in impetigo. 2
When to Consider Cefdinir
Cefdinir may be appropriate as an alternative oral agent when:
- Patient cannot tolerate cephalexin 3
- Twice-daily dosing is preferred for adherence over three or four times daily 1, 4
- Penicillin allergy exists (non-Type I hypersensitivity) 3
Clinical trials demonstrate cefdinir 7 mg/kg twice daily achieves 99.4% microbiologic eradication and 98.3% clinical cure rates in pediatric skin infections, including impetigo. 4 The most common pathogens isolated were S. aureus and S. pyogenes, with excellent activity against both. 4
Administration Details
- May be given without regard to meals 1
- Suspension remains stable for 10 days after reconstitution at room temperature 1
- Shake well before each dose 1
Adverse Effects
Diarrhea is the most common adverse event, occurring in approximately 8% of pediatric patients receiving cefdinir for skin infections. 4 This is slightly higher than cephalexin (4%), though the difference is generally well-tolerated. 4
Critical Pitfall to Avoid
Do NOT use once-daily dosing for skin infections. 1 While once-daily cefdinir is effective for respiratory infections, it has not been studied for skin infections and the FDA label explicitly requires twice-daily administration for this indication. 1
Renal Dosing Adjustment
For pediatric patients with creatinine clearance <30 mL/min/1.73 m², reduce dose to 7 mg/kg (up to 300 mg) once daily. 1 For patients on hemodialysis, give 7 mg/kg every other day, with an additional dose after each dialysis session. 1