Cefdinir is an oral third generation cephalosporin that inhibits bacterial cell wall synthesis. It has a broad spectrum of activity, especially against enteric gram-negative rods. It is indicated for the treatment of the following conditions:

• Treatment of acute exacerbations of Chronic obstructive pulmonary disease in adults and adolescents caused by:

  • Haemophilus influenzae including betalactamase- producing strains
  • Haemophilus parainfluenzae including beta-lactamase-producing strains
  • Penicillin-susceptible strains of Streptococcus pneumoniae
  • Moraxella catarrhalis including beta-lactamase-producing strains.

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• Treatment of acute bacterial Otitis media in children caused by:

  • H. influenzae including beta-lactamase-producing strains
  • Penicillin-susceptible strains of S. pneumoniae
  • M. catarrhalis including beta-lactamase-producing strains.

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• Treatment of community-acquired Pneumonia in adults and adolescents caused by:

  • H. influenzae including beta-lactamase-producing strains
  • H. parainfluenzae including beta-lactamase-producing strains
  • Penicillinsusceptible strains of S. pneumoniae
  • M. catarrhalis including beta-lactamase-producing strains

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• Treatment of acute bacterial maxillary sinusitis in adults and adolescents caused by:

  • H. influenzae including beta-lactamase-producing strains
  • Penicillin-susceptible strains of S. pneumoniae
  • M. catarrhalis including beta-lactamase-producing strains.

Note: Cefdinir is not recommended as monotherapy for the empiric treatment in sinusitis.

• Treatment of Uncomplicated Skin and soft tissue infections caused by:

  • Staphylococcus aureus including beta-lactamase-producing strains
  • Streptococcus pyogenes

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• Treatment of Group A Streptococcal pharyngitis or tonsillitis caused by:

  • Streptococcus pyogenes

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• As Off-Label Use in the treatment of acute uncomplicated and complicated Urinary tract infections in adults.

Cefdinir Dose in Adults

Cefdinir dosage in exacerbations of Chronic obstructive pulmonary disease:

• 300 mg orally twice a day or
• 600 mg orally once a day for 5 to 7 days.

Note: Some experts  reserve its use in patients with uncomplicated COPD defined as age less than 65 years without major comorbidities, FEV of more than 50% predicted, and less frequent exacerbations)

Use in treatment of acute Otitis media (as an alternative agent):

• 300 mg orally twice a day or
• 600 mg once a day for 5 to 7 days in mild to moderate infections and 10 days in severe infections.

Use as an alternative agent in the treatment of community-acquired Pneumonia (pathogen-directed therapy):

Note: Use only for community-acquired pneumonia due to Streptococcus pneumoniae if the penicillin MIC is less than 2 mcg/mL

• 300 mg orally twice a day for a minimum of 5 days
• Patients should be afebrile for 48 hours or more and clinically stable before therapy is discontinued, otherwise, the duration of therapy may be prolonged.

Cefdinir dose in the treatment of Group A Streptococcal pharyngitis (as an alternative agent):

• 300 mg orally twice a day for 5 - 10 days or
• 600 mg once a day for 10 days

Off-label use as an alternative agent in the treatment of Urinary tract infections:

Note: It should be Used only when preferred agents cannot be used.

• Acute uncomplicated cystitis or acute simple cystitis without features of upper urinary tract involvement including prostate and systemic infection:
  • 300 mg orally twice a day for 5 to 7 days.
• Use in the treatment of complicated urinary tract infections including pyelonephritis:
  • 300 mg orally twice a day for 10 to 14 days.

Cefdinir Dose in Childrens

General Cefdinir dosing for susceptible infection:

• Mild to moderate infections in infants, Children, and Adolescents:
  • 14 mg/kg/day orally in 1 to 2 divided doses to a maximum daily dose of 600 mg/day.

Cefdinir dose in the treatment of acute exacerbation of Bronchitis:

• Adolescents:
  • 300 mg orally twice a day for 5 to 10 days or
  • 600 mg orally once a day for 10 days

Dose in the treatment of acute Otitis media as an alternative agent:

• Infants 6 months of age or older and Children:
  • 14 mg/kg/day in one or two divided doses for 5 - 10 days to a maximum daily dose of 600 mg/day.
• Duration of therapy:
  • A 10 days course is recommended if the child is less than 2 years of age or has severe symptoms (any age)
  • A 7 days course is recommended if the child is 2 - 5 years of age with mild to moderate symptoms
  • A 5 - 7 days course is recommended if the child is older than 6 years of age with mild to moderate symptoms.

Cefdinir dose in the treatment of Pharyngitis &Tonsillitis:

Note: Prescribing cefdinir for less than 10 days is not recommended.

• Infants 6 months of age or older and Children:
  • 7 mg/kg/dose orally twice a day for 5 to 10 days or
  • 14 mg/kg/dose orally once a day for 10 days to a maximum daily dose of 600 mg/day.
• Adolescents:
  • 300 mg orally twice a day for 5 - 10 days or
  • 600 mg orally once a day for 10 days

Cefdinir dosage in the treatment of community-acquired Pneumonia:

• Adolescents:
  • 300 mg orally twice a day for 10 days

Cefdinir dosage in the treatment of uncomplicated Skin and soft tissue infections:

• Infants 6 months of age or older and Children:
  • 14 mg/kg/day orally in two divided doses for 10 days to a maximum daily dose of 600 mg/day.
• Adolescents:
  • 300 mg orally twice a day for 10 days

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Cefdinir dosage in the treatment of acute maxillary Sinusitis:

Note: Cefdinir should not be used as a monotherapy for the empiric treatment of sinusitis because of the increasing resistance.

• Infants older than 6 months and Children:
  • 14 mg/kg/day orally in one or two divided doses for 10 days to a maximum daily dose of 600 mg/day.
• Adolescents:
  • 300 mg orally twice a day or
  • 600 mg orally once a day for 10 days

Pregnancy Risk Factor B

• Cefdinir can be used safely during pregnancy, as adverse fetal outcomes and teratogenic effects have not been discovered following exposure in the first trimester.

Cefdinir use duringBreastfeeding:

• Cefdinir cannot be absorbed into breastmilk. 
• Like all antibiotics, children should be closely monitored for any gastrointestinal problems.

Cefdinir dosage adjustment in Renal disease:

• CrCl of 30 mL/minute or more:
  • Dosage adjustment is not necessary
• CrCl of 30 mL/minute or less:
  • 300 mg orally once a day.
• ESRD requiring intermittent hemodialysis (IHD): (63% Dialyzable):
  • 300 mg or 7 mg/kg/dose orally every other day.
  • Administer the drug post-dialysis on the day of dialysis.

Cefdinir Dose in Liver Disease:

Cefdinir dosage adjustment is not necessary in liver disease. 

Common Side Effects Of Cefdinir Include:

• Gastrointestinal:
  • Diarrhea

Less Common Side Effects Of Cefdinir Include:

• Central nervous system:
  • Headache
• Dermatologic:
  • Skin rash
• Endocrine & metabolic:
  • Decreased serum bicarbonate
  • Glycosuria
  • Hyperglycemia
  • Hyperphosphatemia
  • Increased gamma-glutamyl transferase
  • Increased lactate dehydrogenase
• Gastrointestinal:
  • Nausea
  • Abdominal pain
  • Vomiting
• Genitourinary:
  • Vulvovaginal candidiasis
  • Urine abnormality
  • Proteinuria
  • Occult blood in urine
  • Vaginitis
• Hematologic & oncologic:
  • Lymphocytosis
  • Eosinophilia
  • Lymphocytopenia
  • Abnormal neutrophils
  • Thrombocythemia
• Hepatic:
  • Increased serum alkaline phosphatase
  • Increased serum ALT
• Renal:
  • Increased urine pH
  • Increased urine specific gravity

Contraindication to Cefdinir include:

• Allergy reactions to cefdinir or other cephalosporins or any component of this formulation

Warnings and Precautions

• Penicillin allergy
  • Cefdinir may cause allergic reactions. Patients with a history or hypersensitivity reaction (like angioedema or urticaria) to penicillins or cephalosporin should not use it.
• Superinfection
  • Ceftriaxone treatment for longer periods (over 2 months) can lead to superinfections, including fungal or bacterial superinfections. C. difficile-associated diarrhea, (CDAD), and pseudomembranous collitis can occur.
• Colitis
  • Patients who have had colitis or a history of a gastrointestinal disorder should be cautious about taking the drug.
• Renal impairment
  • Patients with kidney impairment, especially those with CrCl less than 30mL/minute, should be cautious when using the drug. Dosage adjustment may be necessary.

Monitor:

• Renal function
• Observe for features of anaphylaxis during first dose.

How to Administer Cefdinir?

• It is administered orally in two divided doses every 12 hours with or without food.
• It should not be administered with antacids or iron supplements.
• The suspension should be shaken well before use.

Mechanism of action of Cefdinir:

Cefdinir

• This is a third-generation cephalosporin. It inhibits the formation bacterial proteins and prevents peptidoglycan formation by binding to penicillin-binding protein eventually leading to cell lysis via autolytic enzymes.
• It is capable of destroying enteric gram-negative rods. ItPermeatesInflammation of the middle ear fluid, tonsils and sinuses, as well as lung tissues, can cause blisters.

60% to 70% of the drug can be found in this categoryprotein-bound.It is minimallyMetabolized. Only 16 to 25% of the drug can be foundbioavailableWhen taken as a suspension or capsule. Thehalf-life eliminationFor patients with normal renal function, it takes approximately 1.7 hours to reach the destination. It takes approximately 1.7 hours to reach the destination.peak plasma concentrationIt takes between 2 and 4 hours. It is primarilyexcretedVia urine

International Brands of Cefdinir:

• Adcef
• Addcef
• Adinir
• Anicef
• Anycef
• Cedenir
• Cednir
• Cefdiar
• Cefnir
• Cefralin
• Cefzon
• Celofarm
• Danircap
• Kefnir
• Maxdinir
• Medsidin
• Nilocef
• Nircef
• Nirocef
• Omicef
• Omnicef
• Omnicef R
• Orcef-DS
• Samnir
• Sefarin
• Sefdin
• Sefdy
• Torbener

Cefdinir brands in Pakistan: