General

Pronunciation:
sef-di-nir

Trade Name(s)

• Omnicef

Ther. Class.

anti-infectives

Pharm. Class.

third generation cephalosporins

Indications

Treatment of the following infections caused by susceptible organisms:

• Community-acquired pneumonia,
• Acute exacerbations of chronic bronchitis,
• Acute maxillary sinusitis,
• Pharyngitis and tonsillitis,
• Uncomplicated skin and skin structure infections,
• Acute bacterial otitis media.

Action

Inhibits bacterial cell wall synthesis.

Therapeutic Effect(s):

Bactericidal action against susceptible bacteria.

Spectrum:

• Active against the following gram-positive organisms:

  • Staphylococcus aureus,
  • Streptococcus pneumoniae,
  • Streptococcus pyogenes.

• Active against the following gram-negative organisms:

  • Haemophilus influenzae (including β-lactamase-producing strains),
  • Haemophilus parainfluenzae (including β-lactamase-producing strains),
  • Moraxella catarrhalis (including β-lactamase-producing strains).
• Not active against methicillin-resistant staphylococci or enterococci.

Pharmacokinetics

Absorption: 16–25% absorbed after oral administration.

Distribution: Widely distributed.

Metabolism and Excretion: Mostly excreted unchanged in urine.

Half-life: 1.7 hr (↑ in renal impairment).

TIME/ACTION PROFILE (plasma concentrations)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity to cephalosporins
• Serious hypersensitivity to penicillins.

Use Cautiously in:

• Renal impairment (↓ dose if CCr <30 mL/min)
• Diabetes (suspension contains sucrose)
• History of GI disease, especially colitis
• OB:  Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
• Pedi:  Children <6 mo (safety and effectiveness not established);
• Geri:  Dose adjustment due to age-related ↓ in renal function may be necessary.

Adverse Reactions/Side Effects

Derm: rash, pruritus

GI: diarrhea, vomiting, abdominal pain, CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), nausea

GU: vaginal moniliasis, vaginitis

Neuro: headache, SEIZURES

Misc: HYPERSENSITIVITY REACTIONS (including anaphylaxis)

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

•  Antacids  and  iron supplements  may ↓ absorption; administer cefdinir ≥2 hr before or 2 hr after these medications.
•   Probenecid  ↓ excretion and ↑ levels.

Route/Dosage

PO (Adults and Children  ≥13 yr): 300 mg every 12 hr  OR  600 mg every 24 hr (twice daily dosing must be used for community-acquired pneumonia or uncomplicated skin and skin structure infections).

PO (Children  6 mo–12 yr): 7 mg/kg every 12 hr  OR  14 mg/kg every 24 hr (not to exceed 600 mg/day). Twice daily dosing must be used for uncomplicated skin and skin structure infections.

Renal Impairment 
(Adults and Children  ≥13 yr): CCr <30 mL/min: 300 mg every 24 hr.

Renal Impairment 
(Children  6 mo-12 yr): CCr <30 mL/min: 7 mg/kg every 24 hr.

Availability (generic available)

Oral suspension (strawberry flavor): 125 mg/5 mL, 250 mg/5 mL

Capsules: 300 mg

Assessment

• Assess signs/symptoms of infection at beginning of and throughout therapy.
• Before initiating therapy, obtain a history to determine previous use of and reaction to penicillins or cephalosporins.
• Monitor for signs/symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing).  If reaction occurs,  discontinue cefdinir and treat as indicated. Keep epinephrine, antihistamine, and resuscitation equipment at hand.
• Monitor for signs/symptoms of CDAD (diarrhea, abdominal cramping, fever, bloody stools).  If CDAD suspected,  discontinue cefdinir and treat as indicated. May begin up to several weeks following cessation of therapy.

Lab Test Considerations:

Obtain specimens for culture and sensitivity before initiating therapy. 1st dose may be given before receiving results.

May cause positive results for Coombs' test.

• May cause ↑ AST, ALT, alkaline phosphatase, bilirubin, LDH, and BUN.
• May rarely cause leukopenia, eosinophilia, lymphocytosis, and thrombocytosis.

Implementation

• PO Administer around the clock without regard to food. Shake oral suspension well before administering. Suspension can be stored at room temperature for up to 10 days.
  • Do not administer within 2 hr before or after antacids or iron supplements.

Patient/Family Teaching

• Explain purpose and side effects of medication. Advise patient to read  Patient Information  before starting therapy.
• Instruct patient to finish the medication completely, even if feeling better. Take missed doses as soon as possible unless almost time for next dose; do not double doses. Instruct patient to use calibrated measuring device with suspension. Advise patient that sharing this medication may be dangerous.
• Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
• Advise patient to notify health care provider if signs/symptoms of superinfection (furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy occur.
• Instruct patient to notify health care provider if fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise patient not to treat diarrhea without consulting health care professional.
• Rep:  Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected, or if breastfeeding.

Evaluation/Desired Outcomes

Resolution of signs/symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.