What is the recommended dose of cefdinir (Omnicef) for an adult patient with Acute Otitis Media (AOM) who has a non-severe reaction to Augmentin (amoxicillin-clavulanate)?

Cefdinir Dosing for Acute Otitis Media in Adults

For an adult with acute otitis media and a non-severe penicillin allergy, cefdinir should be dosed at 300 mg twice daily or 600 mg once daily for 10 days. 1, 2

Rationale for Cefdinir Selection

• Cefdinir is specifically recommended for patients with non-Type I hypersensitivity reactions to penicillin (such as rash), making it appropriate for your patient who had a non-severe reaction to Augmentin 3
• The American Academy of Otolaryngology-Head and Neck Surgery and American Academy of Family Physicians endorse cefdinir as a suitable alternative when penicillin-based therapy is contraindicated 1, 2
• Cefdinir provides excellent coverage against the major AOM pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, with stability against beta-lactamase-producing strains 4, 5

Specific Dosing Regimens

Two equivalent dosing options are available:

• 300 mg orally twice daily 1, 2
• 600 mg orally once daily 1, 2

Both regimens demonstrate clinical efficacy rates of approximately 83-88% in respiratory tract infections including acute otitis media 1, 2

Treatment Duration and Monitoring

• Standard treatment duration is 10 days for acute otitis media 4, 5
• Reassess the patient if no clinical improvement occurs within 48-72 hours of initiating therapy 1, 2
• The patient should stabilize within the first 24 hours and begin improving during the second 24-hour period 1
• If treatment failure occurs after 72 hours, consider switching to an alternative antibiotic with broader coverage 3, 2

Clinical Efficacy Considerations

• Cefdinir demonstrates good tissue penetration into middle ear fluid, sinus tissue, and tonsils, supporting its use in otitis media 4, 5
• In comparative trials, cefdinir showed equivalent clinical and bacteriological efficacy to amoxicillin/clavulanate in treating acute otitis media 6
• Cefdinir is generally better tolerated than amoxicillin/clavulanate, with significantly lower rates of diarrhea (10-13% vs 35%) 6

Important Caveats

• For patients who recently received antibiotics (within 4-6 weeks), cefdinir is particularly appropriate as it provides coverage against potentially resistant organisms 3, 2
• While cefdinir has good activity against penicillin-susceptible and intermediate-resistant S. pneumoniae, it may have reduced efficacy against highly penicillin-resistant strains 6, 7
• Avoid cefdinir in patients with Type I hypersensitivity reactions (anaphylaxis, angioedema) to beta-lactams, as cross-reactivity can occur; in such cases, consider macrolides or fluoroquinolones instead 3