Cefdinir

# Cefdinir ## Overview Cefdinir is a third‑generation oral cephalosporin with broad gram‑positive and gram‑negative activity. It is stable against many β‑lactamases but not against ESBLs or MRSA. ## Primary Indications - Community‑acquired pneumonia (mild‑to‑moderate) - Acute bacterial otitis media - Acute maxillary sinusitis - Pharyngitis/tonsillitis (group A streptococcal) - Uncomplicated skin and soft‑tissue infections ## Adult Dosing - **Most infections (pneumonia, sinusitis, pharyngitis, skin):** 300 mg every 12 hours **or** 600 mg every 24 hours for 10 days (pharyngitis: 5–10 days depending on local protocol). - **Uncomplicated UTI:** Not FDA‑approved; if used, 300 mg twice daily (off‑label). - **Maximum dose:** 600 mg daily. ## Pediatric Dosing (6 months – 12 years) - **Otitis media, sinusitis, pharyngitis:** 7 mg/kg every 12 hours **or** 14 mg/kg every 24 hours. - **Skin infections:** 7 mg/kg every 12 hours for 10 days. - **Maximum:** 600 mg per day (total daily dose). *Exact duration may follow local guidelines (e.g., pharyngitis 10 days).* ## Dose Adjustments - **Renal impairment (CrCl <30 mL/min):** Reduce to 300 mg once daily (adults); for pediatric patients, 7 mg/kg once daily (max 300 mg/dose). - **Hemodialysis:** Give 300 mg (or 7 mg/kg) after each session. - **Hepatic impairment:** No adjustment needed. ## Contraindications - Known hypersensitivity to cefdinir, any cephalosporin, or severe immediate reaction to penicillins (cross‑sensitivity possible). - Avoid in patients with history of cephalosporin‑associated anaphylaxis. ## Adverse Effects - **Common:** Diarrhea (including *Clostridioides difficile*), nausea, abdominal pain, headache, rash. - **Serious (rare):** Seizures (especially with high doses or renal impairment), pseudomembranous colitis, acute interstitial nephritis, hemolytic anemia, serum sickness‑like reactions (more frequent in pediatrics). - **Lab:** False‑positive urine ketones, slight elevation of transaminases. ## Key Drug Interactions - **Iron supplements / antacids (Al, Mg, Ca) / zinc:** Reduce absorption – separate cefdinir by at least 2 hours. - **Probenecid:** Decreases renal elimination → increased cefdinir levels (may increase toxicity risk). - **Warfarin:** May prolong INR – monitor more frequently. - **Live vaccines (eg, typhoid):** Avoid during therapy; cephalosporins may impair response. ## Monitoring - Baseline renal function (especially if CrCl <30 mL/min). - Signs of severe diarrhea, rash, or anaphylactoid reactions. - For prolonged courses or high‑risk patients: periodic CBC, renal function, and *C. difficile* testing if diarrhea develops. ## Clinical Pearls - Suspension has a strong taste – can be mixed with applesauce or juice (stability data support). - Effective against MSSA, *S. pneumoniae*, *H. influenzae* (including β‑lactamase positive), and *M. catarrhalis*. Not active against MRSA, *Pseudomonas*, or *Enterococcus*. - Pediatric twice‑daily dosing may improve adherence; once‑daily option available for many indications. - Always confirm local antibiogram and guidelines. *This information is for educational purposes and is not a substitute for current prescribing information. Always verify dosing, indications, and safety updates from the official product monograph or local formulary before clinical use.*