Cefdinir Should NOT Be Prescribed for Acute Bronchitis in Children
Do not prescribe cefdinir or any antibiotic for uncomplicated acute bronchitis in children, as this is a viral illness that does not benefit from antibacterial therapy. 1, 2
Why Antibiotics Are Not Indicated
Acute bronchitis in children is primarily viral and resolves with supportive care alone, making antibiotics ineffective and unnecessary. 2
The American College of Chest Physicians explicitly recommends against routine antibiotic use for immunocompetent patients with acute bronchitis, as no clinical benefit has been demonstrated. 1
Multiple systematic reviews show no difference in clinical improvement between antibiotic and placebo groups (RR 1.07; 95% CI 0.99-1.15), while adverse events increase with antibiotic use (RR 1.20; 95% CI 1.05-1.36). 1
Antibacterial medications should only be used in children with bronchitis who have specific indications of coexisting bacterial infection, such as pneumonia confirmed by clinical or radiographic findings. 1
When to Consider Antibiotics
Antibiotics may be appropriate only in these specific circumstances:
If the acute bronchitis worsens and a complicating bacterial infection is thought likely (e.g., development of pneumonia, persistent high fever beyond 5-7 days, or clinical deterioration). 1
If pertussis is suspected, a macrolide antibiotic (not cefdinir) is mandatory, and the child should be isolated for 5 days from treatment start. 2
When there is documented bacterial superinfection with appropriate clinical and laboratory evidence supporting bacterial etiology. 1
Appropriate Management Instead
The correct approach for acute bronchitis in children includes:
Supportive care is the primary treatment, focusing on hydration, symptom management, and monitoring for complications. 2
For children with accompanying wheeze, a trial of β2-agonist bronchodilators may be useful, but should only be continued if there is documented clinical improvement in wheezing, respiratory rate, respiratory effort, and oxygen saturation. 2
The American Academy of Pediatrics recommends avoiding routine bronchodilators for uncomplicated acute bronchitis. 2
Corticosteroids should not be used routinely for bronchitis in children, as robust evidence shows no statistically significant benefits for any clinically meaningful outcome. 2
Important Differential Diagnoses to Consider
Before diagnosing acute bronchitis, exclude:
Pneumonia (requires chest examination and possibly chest x-ray if clinically indicated). 1
Asthma exacerbation or cough-variant asthma, particularly if there is wheezing, personal or family history of atopy, or recurrent episodes. 1
Pertussis, especially if there is paroxysmal cough, post-tussive emesis, or known exposure. 2
Antimicrobial Stewardship Considerations
Prescribing antibiotics for viral bronchitis contributes to antimicrobial resistance without providing patient benefit. 1
While cefdinir has good activity against respiratory pathogens like H. influenzae and S. pneumoniae 3, 4, 5, this activity is irrelevant when the infection is viral in nature.
The appropriate antibiotic choice when bacterial infection IS present would be amoxicillin-clavulanate as first-line, with cefdinir as a reasonable alternative for patients with penicillin allergy. 1