No

Antibiotic, Cephalosporin (Third Generation)

Treatment of community-acquired pneumonia, acute exacerbations of chronic bronchitis, acute bacterial otitis media, acute maxillary sinusitis, pharyngitis/tonsillitis, and uncomplicated skin and skin structure infections.

B

Hypersensitivity to cephalosporins or related antibiotics

Administer cautiously to penicillin-sensitive patients. There is evidence of partial cross-allergenicity and cephalosporins cannot be assumed to be an absolutely safe alternative to penicillin in the penicillin-allergic patient. Serum sickness-like reactions have been reported. Signs and symptoms occur after a few days of therapy and resolve a few days after drug discontinuation with no serious sequelae. Pseudomembranous colitis occurs; consider its diagnosis in patients who develop diarrhea with antibiotic use.

>1%: Gastrointestinal: Diarrhea

<1%: Seizures (with high doses and renal dysfunction), headache, nervousness, rash, urticaria, pruritus, Stevens-Johnson syndrome, nausea, vomiting, pseudomembranous colitis, eosinophilia, hemolytic anemia, neutropenia, positive Coombs' test, thrombocytopenia, cholestatic jaundice, slightly increased AST/ALT, arthralgia, nephrotoxicity with transient elevations of BUN/creatinine, interstitial nephritis, serum sickness, candidiasis

After acute overdose, most agents cause only nausea, vomiting, and diarrhea, although neuromuscular hypersensitivity and seizures are possible, especially in patients with renal insufficiency

Hemodialysis may be helpful to aid in the removal of the drug from the blood but not usually indicated, otherwise most treatment is supportive or symptom directed following GI decontamination

Decreased effect: Coadministration with iron or antacids reduces the rate and extent of cefdinir absorption

Increased effect: Probenecid increases the effects of cephalosporins by decreasing the renal elimination in those which are secreted by tubular secretion

Increased toxicity: Anticoagulant effects may be increased when administered with cephalosporins

Oral suspension should be mixed with 39 mL water for the 60 mL bottle and 65 mL of water for the 120 mL bottle. After mixing, the suspension can be stored at room temperature (25°C/77°F). The suspension may be used for 10 days. The suspension should be shaken well before each administration.

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Half-life: 100 minutes

Oral:

Adolescents and Adults: 300 mg twice daily or 600 mg once daily for 10 days

Dosing adjustment in renal impairment: Cl_cr <30 mL/minute: 300 mg once daily

Hemodialysis removes cefdinir; recommended initial dose: 300 mg (or 7 mg/kg/dose) every other day. At the conclusion of each hemodialysis session, 300 mg (or 7 mg/kg/dose) should be given. Subsequent doses (300 mg or 7 mg/kg/dose) should be administered every other day.

Observe for signs and symptoms of anaphylaxis during first dose

May cause nervousness; case reports of euphoria, delusion, illusions, and depersonalization with cephalosporins

May rarely cause neutropenia; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

Capsule: 300 mg

Suspension, oral: 125 mg/5 mL (60 mL, 100 mL)

Marshall WF and Blair JE, "The Cephalosporins," Mayo Clin Proc, 1999, 74(2):187-95.