Can cefdinir (Cefdinir) be used to treat Streptococcus pneumoniae bacteremia of pulmonary origin?

From the Guidelines

Cefdinir is not the preferred treatment for Streptococcus pneumoniae bacteremia of pulmonary origin. For adults, the recommended treatment is typically intravenous ceftriaxone (1-2 grams every 12-24 hours) or cefotaxime (1-2 grams every 8 hours) for 10-14 days, whereas for outpatient treatment, oral amoxicillin-clavulanate (500-875mg every 8-12 hours) or levofloxacin (500-750mg every 24 hours) may be considered 1.

Key Points

• Cefdinir may be used as an alternative for mild cases of community-acquired pneumonia, but its use in bacteremia is not recommended due to concerns about penetration and efficacy.
• The choice of antibiotic should be guided by susceptibility testing and local resistance patterns.
• Combination therapy with a macrolide and a beta-lactam may be considered in certain cases, such as in patients with severe disease or those who are at risk for infection with atypical pathogens.
• Fluoroquinolones, such as levofloxacin, may be used as an alternative to beta-lactams in patients who are allergic to penicillin or have a history of resistance to other antibiotics.

Treatment Considerations

• The treatment of Streptococcus pneumoniae bacteremia should be individualized based on the patient's clinical presentation, underlying health status, and susceptibility testing results.
• Patients with severe disease, such as those with sepsis or meningitis, may require more aggressive treatment, including the use of combination therapy and close monitoring in an intensive care unit.
• Patients with a history of antibiotic resistance or those who have recently received antibiotic therapy may require alternative treatment regimens.
• The use of vancomycin or linezolid may be considered in patients with severe disease or those who are at risk for infection with resistant strains of Streptococcus pneumoniae.

From the FDA Drug Label

Cefdinir for oral suspension is indicated for the treatment of patients with mild to moderate infections caused by susceptible strains of the designated microorganisms in the conditions listed below Adults and Adolescents Community-Acquired Pneumonia caused by Haemophilus influenzae (including β-lactamase producing strains), Haemophilus parainfluenzae (including β-lactamase producing strains), Streptococcus pneumoniae (penicillin-susceptible strains only), and Moraxella catarrhalis (including β-lactamase producing strains)

The answer is: No, cefdinir can be used to treat Streptococcus pneumoniae infections, but only for Community-Acquired Pneumonia caused by penicillin-susceptible strains of Streptococcus pneumoniae. There is no information that directly supports the use of cefdinir for the treatment of Streptococcus pneumoniae bacteremia of pulmonary origin. 2

From the Research

Cefdinir for Streptococcus pneumoniae Bacteremia

• Cefdinir has good in vitro activity against many pathogens, including penicillin-susceptible Streptococcus pneumoniae 3, 4.
• The drug is effective against Streptococcus pneumoniae, but its efficacy in treating bacteremia, particularly of pulmonary origin, is not explicitly stated in the provided studies.
• Cefdinir is stable to hydrolysis by commonly occurring plasmid-mediated beta-lactamases and retains good activity against beta-lactamase-producing strains of H. influenzae and M. catarrhalis 3, 4.
• The clinical efficacy of cefdinir in treating respiratory tract infections, including community-acquired pneumonia, has been demonstrated in several studies 3, 4.

Treatment of Community-Acquired Pneumonia

• The treatment of community-acquired pneumonia (CAP) depends on various factors, including the severity of the disease and the presence of comorbidities 5.
• Cefdinir is an option for the treatment of CAP, particularly in areas where beta-lactamase-mediated resistance among common community-acquired pathogens is a concern 3, 4.
• Other antibiotics, such as levofloxacin, have also been shown to be effective in treating CAP, including infections caused by penicillin-resistant Streptococcus pneumoniae 6.

Bacteremia Treatment

• The treatment of bacteremia requires effective antimicrobial therapy, and the choice of antibiotic depends on various factors, including the causative organism and its susceptibility to different antibiotics 7.
• Ceftriaxone monotherapy has been shown to be effective in treating bacteremia, including short-course treatment regimens 7.
• However, the efficacy of cefdinir in treating Streptococcus pneumoniae bacteremia of pulmonary origin is not explicitly stated in the provided studies.