Cefdinir Pediatric Dosing
For pediatric patients aged 6 months through 12 years, administer cefdinir at 7 mg/kg every 12 hours OR 14 mg/kg once daily (maximum 600 mg/day), with treatment duration of 5-10 days depending on the infection type. 1
Standard Dosing Algorithm
Age-Based Eligibility
- Approved for children ≥6 months through 12 years of age 1
- Adolescents and children ≥43 kg should receive adult dosing (300 mg twice daily or 600 mg once daily) 1
Dosing Options by Indication
Acute Bacterial Otitis Media:
- 7 mg/kg every 12 hours for 5-10 days, OR
- 14 mg/kg once daily for 10 days 1
Acute Maxillary Sinusitis:
- 7 mg/kg every 12 hours for 10 days, OR
- 14 mg/kg once daily for 10 days 1
Pharyngitis/Tonsillitis:
- 7 mg/kg every 12 hours for 5-10 days, OR
- 14 mg/kg once daily for 10 days 1
Uncomplicated Skin and Skin Structure Infections:
- 7 mg/kg every 12 hours for 10 days ONLY 1
- Once-daily dosing has NOT been studied for skin infections and should not be used 1
Practical Weight-Based Dosing Examples
Using the 125 mg/5 mL suspension 1:
- 9 kg (20 lbs): 2.5 mL every 12 hours OR 5 mL once daily
- 18 kg (40 lbs): 5 mL every 12 hours OR 10 mL once daily
- 27 kg (60 lbs): 7.5 mL every 12 hours OR 15 mL once daily
- 36 kg (80 lbs): 10 mL every 12 hours OR 20 mL once daily
- ≥43 kg (95 lbs): 12 mL every 12 hours OR 24 mL once daily (maximum dose)
Special Populations
Renal Impairment
- Creatinine clearance <30 mL/min/1.73 m²: Reduce to 7 mg/kg (up to 300 mg) once daily 1
Hemodialysis Patients
- Initial dose: 7 mg/kg (up to 300 mg) every other day 1
- Post-dialysis supplementation: 7 mg/kg (up to 300 mg) after each hemodialysis session 1
- Maintenance: Continue 7 mg/kg every other day between dialysis sessions 1
Clinical Context and Positioning
Cefdinir is NOT first-line therapy for most pediatric infections. 2 It serves as an alternative when:
- β-lactamase-producing Haemophilus influenzae is suspected in community-acquired pneumonia 2
- Amoxicillin-clavulanate cannot be used 2
- High-dose amoxicillin (90 mg/kg/day) remains superior for resistant pneumococcal infections 2
Administration Guidelines
- May be given without regard to meals 1
- Suspension stability: Use within 10 days after reconstitution; store at room temperature (25°C/77°F) 1
- Shake well before each dose 1
- Superior palatability compared to other oral antimicrobials, improving compliance 3, 4
Critical Pitfalls to Avoid
- Do NOT use once-daily dosing for skin infections - only twice-daily dosing has been studied for this indication 1
- Do NOT exceed 600 mg/day total dose regardless of weight 1
- Do NOT assume equivalence to high-dose amoxicillin-clavulanate - in head-to-head trials for acute otitis media, amoxicillin-clavulanate showed superior cure rates (86.5% vs 71.0%, p=0.001), with cefdinir efficacy decreasing as children aged from 6-24 months 5
- Adjust dose in renal impairment - failure to reduce dosing in CrCl <30 mL/min/1.73 m² risks drug accumulation 1