cefdinir

sef-di-neer (Omnicef)

• PHARMACOTHERAPEUTIC:Third-generation cephalosporin. CLINICAL:Antibiotic.

Community-acquired pneumonia, acute exacerbations of chronic bronchitis, acute maxillary sinusitis, acute bacterial otitis media caused by H. influenzae (including β-lactamase producing strains), S. pneumoniae (penicillin-susceptible strains only), and M. catarrhalis (including β-lactamase producing strains) Pharyngitis/tonsillitis caused by S. pyogenes. Uncomplicated skin and skin structure infections caused by S. aureus (including β-lactamase producing strains) and S. pyogenes. OFF-LABEL: Urinary tract infections.

Contraindications: Hypersensitivity to cefdinir. History of anaphylactic reaction to cephalosporins. Cautions: Hypersensitivity to penicillins; renal impairment.

Binds to bacterial cell membranes, inhibits cell wall synthesis. Therapeutic Effect: Bactericidal.

Widely distributed. Protein binding: 60%–70%. Not appreciably metabolized. Primarily excreted in urine. Minimally removed by hemodialysis. Half-life: 1–2 hrs (increased in renal impairment).

Pregnancy/Lactation: Crosses placenta. Not detected in breast milk. Children: Newborns, infants may have lower renal clearance. Elderly: Age-related renal impairment may require decreased dosage or increased dosing interval.

DRUG: Antacids, iron preparations may interfere with absorption. Probenecid increases concentration/effect. HERBAL: None significant. FOOD: None known. LAB VALUES: May produce false-positive reaction for urine ketones. May increase serum alkaline phosphatase, bilirubin, LDH, ALT, AST.

Capsules: 300 mg. Powder for Oral Suspension: 125 mg/5 mL, 250 mg/5 mL.

PO

• Give without regard to food. Give at least 2 hrs before or after antacids or iron supplements. · Twice-daily doses should be given 12 hrs apart. · Shake oral suspension well before administering. · Store mixed suspension at room temperature for 10 days.

Usual Dosage Range

PO: ADULTS, ELDERLY: 300 mg q12h or 600 mg once daily. CHILDREN 6 MOS–12 YRS: 7 mg/kg q12h or 14 mg/kg once daily. Maximum: 600 mg/day.

Dosage in Renal Impairment

CrCl less than 30 mL/min: 300 mg/day or 7 mg/kg as single daily dose. Maximum: 300 mg. Hemodialysis pts: 300 mg or 7 mg/kg/dose every other day. Maximum: 300 mg.

Dosage in Hepatic Impairment

No dose adjustment.

Frequent: Oral candidiasis, mild diarrhea, mild abdominal cramping, vaginal candidiasis. Occasional: Nausea, serum sickness–like reaction (fever, joint pain; usually occurs after second course of therapy and resolves after drug is discontinued). Rare: Allergic reaction (rash, pruritus, urticaria).

Antibiotic-associated colitis, other superinfections (abdominal cramps, severe watery diarrhea, fever) may result from altered bacterial balance in GI tract. Nephrotoxicity may occur, esp. in pts with preexisting renal disease. Pts with history of penicillin allergy are at increased risk for developing a severe hypersensitivity reaction (severe pruritus, angioedema, bronchospasm, anaphylaxis).

• BASELINE ASSESSMENTObtain CBC, renal function test. Question for hypersensitivity to cefdinir or other cephalosporins, penicillins.INTERVENTION/EVALUATIONObserve for rash. Monitor daily pattern of bowel activity, stool consistency. Mild GI effects may be tolerable (increasing severity may indicate onset of antibiotic-associated colitis). Be alert for superinfection: Fever, vomiting, diarrhea, anal/genital pruritus, oral mucosal changes (ulceration, pain, erythema). Monitor hematology reports.PATIENT/FAMILY TEACHING
• Take antacids 2 hrs before or following medication. · Continue medication for full length of treatment; do not skip doses. · Doses should be evenly spaced. · Report persistent severe diarrhea, rash, muscle aches, fever, enlarged lymph nodes, joint pain.