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Drug Name: Cefdinir

Click on the titles below for drug details

  • Third-generation cephalosporin
  • Binds penicillin-binding proteins
    • Impairs formation of the peptidoglycan layer of cell wall, which leads to cell death
  • Bactericidal.
  • Enteral formulation only (strengths: 125 mg/5 mL; 250 mg/5 mL, strawberry flavored, or 300 mg capsule); strawberry flavored
  • Does not need to be taken with food
  • Doses
    • 14 mg/kg/dose q24 hours or 7 mg/kg BID, maximum 600 mg/day
      • Every 24-hour dosing may be suboptimal for S. pneumoniae -- BID dosing is often helpful when administering cefdinir to maintain time above MIC (if adherence is not a concern)
  • Patients with abnormal renal function (<30 mL/minute/1.73 m2) require renal dosing adjustment, generally extending the dosing interval. Talk to your friendly pharmacist
  • Spectrum:
    • Excellent coverage against S. pneumoniae
    • Gram-negative coverage
      • Susceptible enterobacterales (E. Coli, Klebsiella, P. mirabilis, Serratia, Citrobacter)
      • Neisseria
    • Does NOT cover:
      • Bacteria producing extended-spectrum beta-lactamases or AmpC beta-lactamases
      • Enterococcus
      • Pseudomonas
      • MRSA
    • Indications:
      • Consider alternative options due to poor tissue penetration but can be used for:
        • Acute otitis media
        • Community-acquired pneumonia
      • Streptococcus, Group A, pharyngitis, tonsillitis (penicillin allergy)
      • Limited evidence for:
        • Rhinosinusitis
        • Skin and soft tissue infections
  • Hypersensitivity to cephalosporins
  • Allergic reactions
  • Gastrointestinal adverse events (diarrhea)
  • Increased risk of Clostridium difficile infections
  • Cefdinir has previously been used commonly for S. Pneumoniae and gram-negative infections but there is concern for poor penetration of different spaces in the body (e.g., lung tissue, middle ear fluid, urine). Select alternative agents (amoxicillin/clavulanic acid, cephalexin, cefuroxime) when possible.
  • Diarrhea is a common side effect.
  • May cause red stools, especially when taken with iron-containing foods or supplements (e.g., infant formula). These stools are typically not bloody, just red.
  • Administer at least 2 hours before or after antacids or iron supplements