Cefdinir Dosing for an 11-Year-Old Patient Weighing 74.9 kg
For an 11-year-old patient weighing 74.9 kg, administer cefdinir 300 mg twice daily (600 mg total daily dose), which is the standard adult dosing regimen. 1
Weight-Based Dosing Algorithm
This patient should receive adult dosing because they weigh ≥43 kg. The FDA-approved pediatric dosing chart for cefdinir specifies that patients weighing ≥43 kg (95 lbs) should receive the maximum daily dose of 600 mg, which corresponds to adult dosing of 300 mg twice daily. 1
Dosing Rationale
- The standard pediatric dose of cefdinir is 14 mg/kg/day, up to a maximum of 600 mg per day. 1
- For this 74.9 kg patient, a weight-based calculation (14 mg/kg/day) would yield 1,049 mg/day, but the maximum daily dose is capped at 600 mg regardless of weight. 1
- The FDA labeling explicitly states that pediatric patients weighing ≥43 kg should receive 12 mL twice daily of the 125 mg/5 mL suspension (equivalent to 300 mg twice daily) or 6 mL twice daily of the 250 mg/5 mL suspension (also 300 mg twice daily). 1
Administration Options
Cefdinir can be administered as:
- 300 mg capsules twice daily (most practical for this age and weight)
- Oral suspension: 12 mL of 125 mg/5 mL suspension twice daily OR 6 mL of 250 mg/5 mL suspension twice daily 1
Dosing Frequency by Indication
- Twice-daily dosing (300 mg every 12 hours) is required for uncomplicated skin and skin structure infections. 1
- Once-daily dosing (600 mg every 24 hours) may be used for acute bacterial otitis media, acute maxillary sinusitis, or pharyngitis/tonsillitis, as once-daily dosing for 10 days has been shown to be as effective as twice-daily dosing for these infections. 1, 2
- Once-daily dosing has not been adequately studied for skin infections, so twice-daily administration should be used for these conditions. 1
Treatment Duration
- Acute bacterial otitis media or pharyngitis/tonsillitis: 5 to 10 days 1
- Acute maxillary sinusitis: 10 days 1
- Uncomplicated skin and skin structure infections: 10 days 1
Clinical Efficacy Evidence
Cefdinir demonstrates excellent activity against common respiratory and skin pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. 2, 3 The drug is stable against hydrolysis by 13 common beta-lactamases, making it particularly effective against beta-lactamase-producing strains of H. influenzae and M. catarrhalis. 3, 4
Important Safety Considerations
Cefdinir may be administered without regard to meals, which improves adherence. 1
Common Pitfall: Red Stools
If this patient is taking iron-containing supplements or multivitamins, counsel the family that cefdinir can cause harmless red-colored stools. This occurs when cefdinir or its metabolites bind to ferric ions, forming a nonabsorbable complex that imparts a reddish color to stool. 5 This is not gastrointestinal bleeding and does not require discontinuation of therapy unless it causes significant concern. 5
Adverse Events
Diarrhea is the most common adverse event, occurring more frequently than with some comparator agents (penicillin V, cephalexin), though discontinuation rates are generally similar. 3, 4 The oral suspension has demonstrated superior taste and palatability compared to other oral antimicrobial agents, which may improve adherence in younger patients who might still prefer liquid formulations. 2
Renal Dosing Adjustment
No dose adjustment is needed for this patient assuming normal renal function. However, if creatinine clearance is <30 mL/min, reduce the dose to 300 mg once daily. 1