Dosing and uses of Cefdinir
Adult dosage forms and strengths
capsule
- 300mg
oral suspension
- 125mg/5mL
- 250mg/5mL
Community-Acquired Pneumonia
Disease caused by Haemophilus influenzae (including beta-lactamase-producing strains), Haemophilus parainfluenzae (including beta-lactamase-producing strains), Streptococcus pneumoniae (penicillin-susceptible strains only), or Moraxella catarrhalis (including beta-lactamase-producing strains)
300 mg PO q12hr for 10 days
Respiratory Tract Infections
Acute exacerbations of chronic bronchitis caused by H influenzae (including beta-lactamase-producing strains), H parainfluenzae (including beta-lactamase-producing strains), S pneumoniae (penicillin-susceptible strains only), or M catarrhalis (including beta-lactamase-producing strains); pharyngitis and tonsillitis caused by Streptococcus pyogenes
300 mg PO q12hr for 5-10 days or 600 mg PO q24hr for 10 days
Acute Maxillary Sinusitis
Disease caused by H influenzae (including beta-lactamase-producing strains), S pneumoniae (penicillin-susceptible strains only), or M catarrhalis (including beta-lactamase-producing strains)
300 mg PO q12hr or 600 mg PO q24hr for 10 days
Skin/Skin Structure Infections
Uncomplicated infections caused by Staphylococcus aureus (including beta-lactamase-producing strains) or S pyogenes
300 mg PO q12hr for 10 days
Dosing Modifications
Renal impairment
- CrCl <30 mL/min (adults): Not to exceed 300 mg/day PO
- CrCl <30 mL/min (children): 7 mg/kg PO q24hr; not to exceed 300 mg/day
Hepatic impairment
- No dosage adjustment necessary
Pediatric dosage forms and strengths
capsule
- 300mg
oral suspension
- 125mg/5mL
- 250mg/5mL
Acute Bacterial Otitis Media
Disease caused by H influenzae (including beta-lactamase-producing strains), S pneumoniae (penicillin-susceptible strains only), or M catarrhalis (including beta-lactamase-producing strains)
<6 months: Safety and efficacy not established
6 months-12 years: 7 mg/kg PO q12hr for 5-10 days or 14 mg/kg PO q24hr for 10 days
Pharyngitis/Tonsillitis
Disease caused by S pyogenes
<6 months: Safety and efficacy not established
6 months-12 years: 7 mg/kg PO q12hr for 5-10 days or 14 mg/kg PO q24hr for 10 days
>12 years or >43 kg: 300 mg PO q12hr for 5-10 days or 600 mg PO q24hr for 10 days
Acute Maxillary Sinusitis
Disease caused by H influenzae (including beta-lactamase-producing strains), S pneumoniae (penicillin-susceptible strains only), or M catarrhalis (including beta-lactamase-producing strains)
<6 months: Safety and efficacy not established
6 months-12 years: 7 mg/kg PO q12hr or 14 mg/kg PO q24hr for 10 days
>12 years or >43 kg: 300 mg PO q12hr or 600 mg PO q24hr for 10 days
Skin/Skin Structure Infections
Uncomplicated infections caused by S aureus (including beta-lactamase-producing strains) or S pyogenes
<6 months: Safety and efficacy not established
6 months-12 years: 7 mg/kg PO q12hr for 10 days
>12 years or >43 kg: 300 mg PO q12hr for10 days
Administration
Coadministration with iron-containing supplements
- Iron interferes with cefdinir absorption; administer cefdinir at least 2 hours before or after iron supplements
- Iron-fortified infant formula does not significantly interfere with cefdinir absorption, therefore, cefdinir can be administered with iron-fortified infant formula
- Reddish stools in patients receiving cefdinir have been reported; in many cases, patients were also receiving iron-containing products; reddish color is due to formation of nonabsorbable complex between cefdinir or its breakdown products and iron in GI tract
Cefdinir adverse (side) effects
>10%
Diarrhea (8-15%)
1-10%
Vaginal moniliasis (<4%)
Nausea (3%)
Rash (3%)
Headache (2%)
Increased urine leukocytes (2%)
Increased urine protein (1-2%)
Decreased lymphocytes (1%)
Glycosuria (1%)
Increased alkaline phosphatase (1%)
Increased eosinophils (1%)
Increased platelets (1%)
Warnings
Contraindications
Documented hypersensitivity
Cautions
Note differences between twice-daily and once-daily dosing regimens
Use with caution in patients with history of penicillin allergy; if allergic reaction to cefdinir occurs, discontinue therapy
Dosage adjustments may be necessary if CrCl is <30 mL/min
Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy
Use caution in patients with history of colitis
Antacids containing magnesium or aluminum interfere with absorption of cefdinir; if this required during therapy, administer at least 2 hr before or after antacid
Iron supplements, including multivitamins that contain iron, interfere with absorption of cefdinir; if iron supplements required administer at least 2 hours before or after supplement
Pregnancy and lactation
Pregnancy category: B
Lactation: Unknown whether drug is excreted in milk
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Cefdinir
Mechanism of action
Third-generation cephalosporin; inhibits mucopeptide synthesis in bacterial cell wall; typically bactericidal, depending on organism susceptibility, dose, and serum or tissue concentrations
Absorption
Bioavailability: 16-21% (capsule); 25% (suspension)
Peak plasma time: 2-4 hr
Plasma protein: 60-70%
Distribution
Distributed into blister fluid, middle-ear fluid, tonsils, sinus tissue, bronchial mucosa, epithelial lining fluid
Vd: 0.29-1.05 L/kg (6 months-12 years); 0.06-0.64 L/kg (adults)
Metabolism
Not appreciably metabolized
Elimination
Half-life: 100 min
Excretion: Urine (7-25% as unchanged drug)
