Action

Interferes with bacterial cell-wall synthesis and division by binding to cell wall, causing cell to die. Active against gram-negative and gram-positive bacteria, with expanded activity against gram-negative bacteria. Exhibits minimal immunosuppressant activity.

Availability

Capsules: 300 mg

Oral suspension: 125 mg/5 ml in 60-and 100-ml bottles

Indications and dosages

➣ Acute bacterial otitis media caused by Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis

Adults and children ages 13 and older: 300 mg P.O. q 12 hours or 600 mg P.O. q 24 hours for 10 days

Children ages 6 months to 12 years: 7 mg/kg P.O. q 12 hours for 5 to 10 days or 14 mg/kg P.O. q 24 hours for 10 days

➣ Uncomplicated skin and soft-tissue infections caused by Staphylococcus aureus and Streptococcus pyogenes

Adults and children ages 13 and older: 300 mg P.O. q 12 hours for 10 days. Maximum dosage is 600 mg/day.

➣ Acute maxillary sinusitis caused by H. influenzae, S. pneumoniae, and M. catarrhalis

Adults and children ages 13 and older: 300 mg P.O. q 12 hours or 600 mg P.O. q 24 hours for 10 days. Maximum dosage is 600 mg/day.

Children ages 6 months to 12 years: 7 mg/kg P.O. q 12 hours or 14 mg/kg P.O. q 24 hours for 10 days

➣ Pharyngitis or tonsillitis caused by S. pyogenes, chronic bronchitis caused by H. influenzae, S. pneumoniae, and M. catarrhalis

Adults and children ages 13 and older: 300 mg P.O. q 12 hours for 5 to 10 days or 600 mg P.O. q 24 hours for 10 days. Maximum dosage is 600 mg/day.

➣ Community-acquired pneumonia caused by H. influenzae, Haemophilus parainfluenzae, S. pneumoniae, and M. catarrhalis

Adults and children ages 13 and older: 300 mg P.O. q 12 hours for 10 days. Maximum dosage is 600 mg/day.

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to cephalosporins or penicillins

Precautions

Use cautiously in:

• renal impairment, phenylketonuria

• history of GI disease (especially colitis)

• elderly patients

• pregnant or breastfeeding patients

• children.

Administration

• Obtain specimens for culture and sensitivity tests as necessary before starting therapy.

• Give with or without food.

• Administer 2 hours before or after iron supplements or antacids containing aluminum or magnesium.

• Give capsules, if possible, to diabetic patients (oral suspension contains 2.86 g of sucrose per teaspoon).

Adverse reactions

CNS: headache, lethargy, paresthesia, syncope, seizures

CV: hypotension, palpitations, chest pain, vasodilation

EENT: hearing loss

GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis,

pseudomembranous colitis

GU: vaginal candidiasis, nephrotoxicity

Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression

Hepatic: hepatomegaly, hepatic failure

Musculoskeletal: arthralgia

Respiratory: dyspnea

Skin: chills, fever, urticaria, maculopapular or erythematous rash

Other: superinfection, anaphylaxis, serum sickness

Interactions

Drug-drug. Aminoglycosides, loop diuretics: increased risk of nephrotoxicity

Antacids, iron-containing preparations: decreased cefdinir absorption

Probenecid: decreased excretion and increased blood level of cefdinir

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase: increased levels
Coombs' test, urinary 17-ketosteroids, nonenzyme-based urine glucose tests (such as Clinitest): false-positive results

Hemoglobin, platelets, white blood cells: decreased values

Drug-herbs. Angelica, anise, arnica, asafetida, bogbean, boldo, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, horse chestnut, horseradish, licorice, meadowsweet, onion, ginseng, papain, passionflower, poplar, prickly ash, quassia, red clover, turmeric, wild carrot, wild lettuce, willow: increased risk of bleeding

Patient monitoring

• Monitor CBC and kidney and liver function test results.

• Monitor for signs and symptoms of superinfection and other serious adverse reactions.

Patient teaching

• Tell patient he may take drug with or without food.

• Instruct patient to report persistent diarrhea (more than four episodes daily) and other adverse effects.

• If patient uses antacids or iron-containing preparations (such as iron supplements), tell him to take these 2 hours before or after cefdinir.

• Inform patient that drug may temporarily discolor stools.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.