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Generic Name: Cefdinir
Class: Third Generation Cephalosporins
Molecular Formula: C14H13N5O5S2
CAS Number: 91832-40-5

Introduction

Antibacterial; β-lactam antibiotic; aminothiazolyl third generation cephalosporin.1 2 3 4 5 6 40

Uses for Omnicef

Acute Otitis Media (AOM)

Treatment of AOM caused by Streptococcus pneumoniae (penicillin-susceptible strains only), Haemophilus influenzae (including β-lactamase-producing strains), or Moraxella catarrhalis (including β-lactamase-producing strains).1 12 37 40

When anti-infectives indicated, AAP recommends high-dose amoxicillin or amoxicillin and clavulanate as drugs of choice for initial treatment of AOM; certain cephalosporins (cefdinir, cefpodoxime, cefuroxime, ceftriaxone) recommended as alternatives for initial treatment in penicillin-allergic patients without a history of severe and/or recent penicillin-allergic reactions.37

Pharyngitis and Tonsillitis

Treatment of pharyngitis and tonsillitis caused by susceptible S. pyogenes (group A β-hemolytic streptococci).1 6 25 40 Generally effective in eradicating S. pyogenes from nasopharynx; efficacy in prevention of subsequent rheumatic fever not established to date.1 10 11 16 17 40

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Always get your pet's drug and dose recommendation from the veterinarian.

AAP, IDSA, AHA, and others recommend a penicillin regimen (10 days of oral penicillin V or oral amoxicillin or single dose of IM penicillin G benzathine) as treatment of choice for S. pyogenes pharyngitis and tonsillitis;10 11 16 17 other anti-infectives (oral cephalosporins, oral macrolides, oral clindamycin) recommended as alternatives in penicillin-allergic patients.10 11 16 17

If an oral cephalosporin used, 10-day regimen of first generation cephalosporin (cefadroxil, cephalexin) preferred instead of other cephalosporins with broader spectrums of activity (e.g., cefaclor, cefdinir, cefixime, cefpodoxime, cefuroxime).10 16 17

Respiratory Tract Infections

Treatment of acute maxillary sinusitis caused by susceptible S. pneumoniae (penicillin-susceptible strains only), H. influenzae (including β-lactamase-producing strains), or M. catarrhalis (including β-lactamase-producing strains).1 7 40 Because of variable activity against S. pneumoniae and H. influenzae, IDSA no longer recommends second or third generation oral cephalosporins for empiric monotherapy of acute bacterial sinusitis.43 Oral amoxicillin or amoxicillin and clavulanate usually recommended for empiric treatment.43 44 If an oral cephalosporin used as an alternative in children (e.g., in penicillin-allergic individuals), combination regimen that includes a third generation cephalosporin (cefixime or cefpodoxime) and clindamycin (or linezolid) recommended.43 44

Treatment of mild to moderate acute exacerbations of chronic bronchitis caused by susceptible S. pneumoniae (penicillin-susceptible strains only) or β-lactamase- and non-β-lactamase-producing H. influenzae, H. parainfluenzae, or M. catarrhalis.1 15 40

Treatment of mild to moderate community-acquired pneumonia (CAP) caused by susceptible S. pneumoniae (penicillin-susceptible strains only) or β-lactamase- and non-β-lactamase-producing strains of H. influenzae, H. parainfluenzae, or M. catarrhalis.1 4 40 If an oral cephalosporin used as an alternative to penicillin G or amoxicillin for treatment of CAP caused by penicillin-susceptible S. pneumoniae, ATS and IDSA recommend cefdinir, cefditoren, cefpodoxime, cefprozil, or cefuroxime.39

Skin and Skin Structure Infections

Treatment of uncomplicated skin and skin structure infections caused by Staphylococcus aureus (including β-lactamase-producing strains) or S. pyogenes.1 5 24 40

Omnicef Dosage and Administration

Administration

Oral Administration

Administer orally.1 4 5 6 7 12 15 24 40

Capsules and oral suspension may be given without regard to meals.1 40 (See Food under Pharmacokinetics.)

For most infections, may be given once daily or in 2 divided doses every 12 hours; once-daily regimen not recommended for treatment of CAP or skin and skin structure infections.1 40

Reconstitution

Reconstitute oral suspension at time of dispensing by adding amount of water specified on the container in 2 portions; invert bottle and shake after each addition.40

Reconstituted suspension contains 125 or 250 mg of cefdinir/5 mL.40

Shake suspension well prior to administration of each dose.40

Dosage

Pediatric Patients

General Pediatric Dosage
Oral

Children beyond neonatal period: AAP recommends 14 mg/kg daily in 1 or 2 equally divided doses for treatment of mild or moderate infections.10 AAP states the drug is inappropriate for treatment of severe infections.10

Acute Otitis Media (AOM)
Oral

Children 6 months through 12 years of age weighing <43 kg: 14 mg/kg once daily for 10 days1 40 or 7 mg/kg every 12 hours for 5–10 days.1 40

AAP does not recommend oral anti-infective regimens of <10 days’ duration in children <2 years of age or in patients with severe symptoms.37

Pharyngitis and Tonsillitis
Oral

Children 6 months through 12 years of age weighing <43 kg: 14 mg/kg once daily for 10 days1 40 or 7 mg/kg every 12 hours for 5–10 days.1 40

Children ≥13 year of age or weighing ≥43 kg: 600 mg once daily for 10 days1 or 300 mg every 12 hours for 5–10 days.1

IDSA and AHA do not recommend cephalosporin regimens of ≤5 days’ duration.16 17

Respiratory Tract Infections
Acute Sinusitis
Oral

Children 6 months through 12 years of age weighing <43 kg: 14 mg/kg once daily for 10 days1 40 or 7 mg/kg every 12 hours for 10 days.1 40

Children ≥13 years of age or weighing ≥43 kg: 600 mg once daily for 10 days1 or 300 mg every 12 hours for 10 days.1

Acute Exacerbations of Chronic Bronchitis
Oral

Children ≥13 year of age: 600 mg once daily for 10 days1 or 300 mg every 12 hours for 5–10 days.1

Community-acquired Pneumonia
Oral

Children ≥13 year of age: 300 mg every 12 hours for 10 days.1

Skin and Skin Structure Infections
Oral

Children 6 months through 12 years of age weighing <43 kg: 7 mg/kg every 12 hours for 10 days.1 40

Children ≥13 year of age or weighing ≥43 kg: 300 mg every 12 hours for 10 days.1

Adults

Pharyngitis and Tonsillitis
Oral

600 mg once daily for 10 days1 or 300 mg every 12 hours for 5–10 days.1

IDSA and AHA do not recommend cephalosporin regimens of ≤5 days’ duration.16 17

Respiratory Tract Infections
Acute Sinusitis
Oral

600 mg once daily for 10 days1 or 300 mg every 12 hours for 10 days.1

Acute Exacerbations of Chronic Bronchitis
Oral

600 mg once daily for 10 days1 or 300 mg every 12 hours for 5–10 days.1

Community-acquired Pneumonia
Oral

300 mg every 12 hours for 10 days.1

Skin and Skin Structure Infections
Oral

300 mg every 12 hours for 10 days.1

Prescribing Limits

Pediatric Patients

Oral

Maximum 600 mg daily.1 40

Adults

Oral

Maximum 600 mg daily.1

Special Populations

Hepatic Impairment

Dosage adjustments not required.1 40

Renal Impairment

Dosage adjustments recommended in patients with severe renal impairment (Clcr <30 mL/minute) or undergoing hemodialysis.1 40

Adults with Clcr <30 mL/minute: 300 mg once daily.1 40

Children with Clcr <30 mL/minute per 1.73 m2: 7 mg/kg (maximum 300 mg) once daily.1 40

Patients maintained on long-term hemodialysis: Recommended initial dosage is 300 mg every 48 hours in adults or 7 mg/kg (maximum 300 mg) every 48 hours in children.1 40 Administer a supplemental dose (300 mg in adults or 7 mg/kg in children) at end of each dialysis period.1 40

Geriatric Patients

No dosage adjustments except those related to renal impairment.1 40 (See Renal Impairment under Dosage and Administration.)

Cautions for Omnicef

Contraindications

  • Known hypersensitivity to cefdinir or other cephalosporins.1 40

Warnings/Precautions

Warnings

Superinfection/Clostridium difficile-associated Diarrhea and Colitis (CDAD)

Possible emergence and overgrowth of nonsusceptible organisms with prolonged use.1 Careful observation of the patient is essential.1 40 Institute appropriate therapy if superinfection occurs.1 40

Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile.1 40 42 C. difficile infection (CDI) and C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) reported with nearly all anti-infectives, including cefdinir, and may range in severity from mild diarrhea to fatal colitis.1 40 42 C. difficile produces toxins A and B which contribute to development of CDAD;1 40 42 hypertoxin-producing strains of C. difficile are associated with increased morbidity and mortality since they may be refractory to anti-infectives and colectomy may be required.1 40

Consider CDAD if diarrhea develops during or after therapy and manage accordingly.1 40 42 Obtain careful medical history since CDAD may occur as late as 2 months or longer after anti-infective therapy is discontinued.1 40 42

If CDAD is suspected or confirmed, discontinue anti-infectives not directed against C. difficile whenever possible.1 40 42 Initiate appropriate supportive therapy (e.g., fluid and electrolyte management, protein supplementation), anti-infective therapy directed against C. difficile (e.g., metronidazole, vancomycin), and surgical evaluation as clinically indicated.1 40 42

Sensitivity Reactions

Hypersensitivity Reactions

Possible hypersensitivity reactions such as urticaria, pruritus, rash (maculopapular, erythematous, morbilliform), fever and chills, eosinophilia, joint pain or inflammation, edema, erythema, genital and anal pruritus, angioedema, shock, hypotension, vasodilatation, Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, exfoliative dermatitis, and anaphylaxis.1 40

If an allergic reaction occurs, discontinue cefdinir and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, and maintenance of an adequate airway and oxygen).1 40

Cross-hypersensitivity

Partial cross-sensitivity among cephalosporins and other β-lactam antibiotics, including penicillins and cephamycins.1 10 20 21 40

Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to cephalosporins, penicillins, or other drugs.1 40 Cautious use recommended in individuals hypersensitive to penicillins:1 40 avoid use in those who have had an immediate-type (anaphylactic) hypersensitivity reaction 10 21 and administer with caution in those who have had a delayed-type (e.g., rash, fever, eosinophilia) reaction.a

General Precautions

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of cefdinir and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.1 40

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.1 40 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.1 40

History of GI Disease

Use cephalosporins with caution in patients with a history of GI disease, particularly colitis.1 40 (See Superinfection/Clostridium-difficile-associated Diarrhea and Colitis under Cautions.)

Diabetes Mellitus

Depending on the manufacturer, reconstituted oral suspension contains 1.37–2.86 g of sucrose per 5 mL.40 41

Specific Populations

Pregnancy

Category B.1 40

Lactation

Not detected in milk.1 40

Pediatric Use

Safety and efficacy not established in neonates and infants <6 months of age.1 40

Use for treatment of acute maxillary sinusitis in children 6 months through 12 years of age supported by evidence from studies in adults and adolescents, similar pathophysiology of acute sinusitis in adults and children, and data regarding cefdinir pharmacokinetics in children.1 40

Adverse effects reported in pediatric patients similar to those in adults.1 40 Increased incidence of diarrhea and rash in pediatric patients ≤2 years of age compared with older pediatric patients.1 40

Geriatric Use

Well tolerated in geriatric patients; incidence of adverse effects (including diarrhea) lower than in younger adults.1 40

Hepatic Impairment

Hepatic metabolism is negligible; dosage adjustments not required.1 40

Renal Impairment

Increased plasma half-life and decreased total body clearance.1 40

Dosage adjustments necessary in patients with severe renal impairment (Clcr <30 mL/minute) or undergoing hemodialysis.1 40 (See Renal Impairment under Dosage and Administration.)

Careful clinical observation and renal function tests recommended prior to and during cephalosporin therapy.a

Common Adverse Effects

GI effects (diarrhea, nausea) and rash.1

Interactions for Omnicef

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Antacids (aluminum- or magnesium-containing)

Decreased cefdinir absorption1 40

Administer cefdinir at least 2 hours before or after aluminum- or magnesium-containing antacids1 40

Iron supplements (multivitamin and mineral preparations containing iron)

Decreased cefdinir absorption1 8 40

Concomitant administration with iron-fortified infant formula (2.2 mg elemental iron/180 mL) has no effect on cefdinir pharmacokinetics1 40

Effect of iron-fortified food (e.g., iron-fortified breakfast cereal) has not been studied1 40

Possibility of reddish stools because of a nonabsorbable complex between cefdinir and iron in the GI tract1 40

Administer cefdinir at least 2 hours before or after oral iron preparations1 8 40

Can be administered concomitantly with iron-fortified infant formula1 40

Nephrotoxic drugs

Potential for increased risk of nephrotoxicitya

Avoid concomitant use of nephrotoxic agents (e.g., aminoglycosides, colistin, polymyxin B, vancomycin) if possiblea

Probenecid

Decreased renal excretion of cefdinir and increased cefdinir serum concentrations and half-life1 40

Tests for glucose

Possible false-positive reactions in urine glucose tests using Clinitest, Benedict’s solution, or Fehling’s solution1 40

Use glucose tests based on enzymatic glucose oxidase reactions (e.g., Clinistix, Tes-Tape)1 40

Tests for ketones

Possible false-positive reactions in urine ketone tests using nitroprusside; no effect on nitroferricyanide tests1 40

Omnicef Pharmacokinetics

Absorption

Bioavailability

16–25%.1 40 Peak plasma concentrations attained 2–4 hours after an oral dose.1 23 27 28 40

Bioavailability of oral suspension is 120% of that reported with capsules.1 40

Food

Administration of cefdinir capsules or oral suspension with a high-fat meal decreases rate and extent of absorption;1 28 40 not considered clinically important.1 40

Special Populations

Peak plasma concentrations and AUC may be higher in geriatric patients than in younger adults.1 40

Distribution

Extent

Distributed into blister fluid, middle ear fluid, tonsils, sinus tissue, and bronchial mucosa and epithelial lining fluid in concentrations ranging from 15–48% of concurrent plasma concentrations.1 22 23 40

Not known whether distributed into CSF.1 40

Not detected in milk following single 600-mg oral dose.1 40

Plasma Protein Binding

60–70% in adult and pediatric patients;1 40 binding is independent of concentration.1 23 40

Elimination

Metabolism

Not appreciably metabolized.1 40

Elimination Route

Eliminated principally by renal excretion;1 40 approximately 12–18% eliminated unchanged in urine.1 40

Half-life

1.7–1.8 hours in adults with normal renal function.1 27 40

Special Populations

Pharmacokinetics not studied to date in hepatic impairment.1 40

Clearance decreased in renal impairment.1 40 Plasma elimination half-life 2 times higher in patients with Clcr 30–60 mL/minute and 5 times higher in those with Clcr <30 mL/minute compared with normal renal function.1 40

Stability

Storage

Oral

Capsules

20–25°C (may be exposed to 15–30°C).1

For Suspension

20–25°C (may be exposed to 15–30°C).40 41 Following reconstitution, store suspension in tight container at controlled room temperature; discard after 10 days.40 41

Actions and Spectrum

  • Third generation cephalosporin2 3 4 5 6 with an expanded spectrum of activity against aerobic gram-negative bacteria compared with first and second generation cephalosporins.2 3 4 5 6 7 9 13 14

  • Usually bactericidal.1 40

  • Like other β-lactam antibiotics, antibacterial activity results from inhibition of bacterial cell wall synthesis.1 40 a

  • In vitro spectrum of activity includes many gram-positive aerobic bacteria and some gram-negative aerobic bacteria; inactive against anaerobic bacteria, fungi, and viruses.1 40 a

  • Usually less active in vitro against susceptible staphylococci than first generation cephalosporins,a however more active against susceptible staphylococci and streptococci than many other oral third generation cephalosporins (e.g., cefixime, cefpodoxime, ceftibuten).2 9 a

  • Gram-positive aerobes: Active in vitro and in clinical infections against S. pneumoniae (penicillin-susceptible strains only), S. pyogenes (group A β-hemolytic streptococci), and Staphylococcus aureus.1 40 Also active in vitro against S. agalactiae (group B streptococci), S. epidermidis (methicillin-susceptible [oxacillin-susceptible] strains only), and viridans streptococci.1 40 Enterococci (e.g., Enterococcus faecalis)1 3 40 and methicillin-resistant (oxacillin-resistant) staphylococci are resistant.1 3 40

  • Gram-negative aerobes: Active in vitro and in clinical infections against non-β-lactamase-producing and β-lactamase-producing strains of H. influenzae, H. parainfluenzae, and M. catarrhalis.1 40 Also active in vitro against Citrobacter diversus, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis.1 40 Inactive against most strains of Enterobacter and Pseudomonas aeruginosa.2 3

  • Stable in the presence of a wide variety of β-lactamases produced by gram-negative and gram-positive bacteria; may be hydrolyzed by certain plasmid-mediated extended-spectrum β-lactamases.9 13 14 19

  • Strains of staphylococci resistant to penicillinase-resistant penicillins (methicillin-resistant [oxacillin-resistant] staphylococci) should be considered resistant to cefdinir, although results of in vitro susceptibility tests may indicate that the organisms are susceptible to the drug.38

Advice to Patients

  • Advise patients that antibacterials (including cefdinir) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).1 40

  • Importance of completing full course of therapy, even if feeling better after a few days.1 40

  • Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with cefdinir or other antibacterials in the future.1 40

  • Advise patients that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued.1 40 Importance of contacting a clinician if watery and bloody stools (with or without stomach cramps and fever) occur during or as late as 2 months or longer after the last dose.1 40

  • Importance of taking cefdinir at least 2 hours before or after antacids containing aluminum or magnesium or iron supplements (including multivitamins containing iron).1 40

  • Importance of discontinuing cefdinir and informing clinician if an allergic reaction occurs.1 40

  • For patients with diabetes, importance of being informed of sucrose content of oral suspension.40

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, or concomitant illness.1 40

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1 40

  • Importance of informing patients of other important precautionary information.1 40 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Cefdinir

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

300 mg*

Cefdinir Capsules

For suspension

125 mg/5 mL*

Cefdinir for Suspension

250 mg/5 mL*

Cefdinir for Suspension

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Cefdinir 125MG/5ML Suspension (TEVA PHARMACEUTICALS USA): 60/$47.99 or 120/$85.98

Cefdinir 300MG Capsules (LUPIN PHARMACEUTICALS): 20/$55.99 or 60/$135.96

Omnicef 125MG/5ML Suspension (ABBOTT): 100/$95.43 or 300/$273.32

Omnicef 250MG/5ML Suspension (ABBOTT): 100/$179.99 or 300/$509.98

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions September 27, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

1. Teva Pharmaceuticals USA. Cefdinir capsules prescribing information. Sellersville, PA; 2009 Dec.

2. Sultan T, Baltch AL, Smith RP et al. In vitro activity of cefdinir (FK482) and ten other antibiotics against gram-positive and gram-negative bacteria isolated from adult and pediatric patients. Chemotherapy. 1994; 40:80-91. [IDIS 325729] [PubMed 8131638]

3. Marchese A, Saverino D, Debbia EA et al. Antistaphylococcal activity of cefdinir, a new oral third-generation cephalosporin, alone and in combination with other antibiotics, at supra- and sub-MIC levels. J Antimicrob Chemother. 1995; 35:53-66. [IDIS 343749] [PubMed 7768782]

4. Drehobl M, Bianchi P, Keyserling CH et al. Comparison of cefdinir and cefaclor in treatment of community-acquired pneumonia. Antimicrob Agents Chemother. 1997; 41:1579-83. [IDIS 389493] [PubMed 9210689]

5. Tack KJ, Keyserling CH, McCarty J et al et al. Study of use of cefdinir versus cephalexin in treatment of skin infections in pediatric patients. Antimicrob Agents Chemother. 1997; 41:739-42. [IDIS 384384] [PubMed 9087480]

6. Tack KJ, Hedrick JA, Rothstein E et al. A study of 5-day cefdinir treatment for streptococcal pharyngitis in children. Arch Pediatr Adolesc Med. 1997; 151:45-9. [IDIS 379950] [PubMed 9006528]

7. Gwaltney JM Jr, Savolainen S, Rivas P et al et al. Comparative effectiveness and safety of cefdinir and amoxicillin-clavulanate in treatment of acute community-acquired bacterial sinusitis. Antimicrob Agents Chemother. 1997; 41:1517-20. [IDIS 389488] [PubMed 9210677]

8. Ueno K, Tanaka K, Tsujimura K et al. Impairment of cefdinir absorption by iron ion. Clin Pharmacol Ther. 1993; 54:473-5. [IDIS 323601] [PubMed 8222489]

9. Cohen MA, Joannides ET, Roland GE et al. In vitro evaluation of cefdinir (FK482), a new oral cephalosporin with enhanced antistaphylococcal activity and β-lactamase stability. Diagn Microbiol Infect Dis. 1994; 18:31-9. [PubMed 8026155]

10. American Academy of Pediatrics. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012.

11. Anon. Drugs for bacterial infections. Med Lett Treat Guid. 2010; 8:43-52.

12. Adler M, McDonald PJ, Trostmann U et al. Cefdinir versus amoxicillin/clavulanic acid in the treatment of suppurative acute otitis media in children. Eur J Clin Microbiol Infect Dis. 1997; 16:214-9. [PubMed 9131324]

13. Payne DJ, Amyes SGB. Stability of cefdinir (CI-983, FK482) to extended-spectrum plasmid-mediated β-lactamases. J Med Microbiol. 1993; 38:114-7. [PubMed 8429536]

14. Labia R, Morand A. Interaction of cefdinir with beta-lactamases. Drugs Exp Clin Res. 1994; 20:43-8. [PubMed 7924895]

15. Sperling MJ, Puopolo A, Griffin TJ et al. Efficacy and safety of cefdinir in the treatment of patients with acute bronchitis. Clin Ther. 1996; 18:626-34. [IDIS 373579] [PubMed 8879891]

16. Shulman ST, Bisno AL, Clegg HW et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012; 55:1279-82. [PubMed 23091044]

17. Gerber MA, Baltimore RS, Eaton CB et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009; 119:1541-51. [PubMed 19246689]

18. Pichichero ME, Cohen R. Shortened course of antibiotic therapy for acute otitis media, sinusitis and tonsillopharyngitis. Pediatr Infect Dis J. 1997; 16:680-95. [IDIS 390075] [PubMed 9239773]

19. Moosdeen F. The evolution of resistance to cephalosporins. Clin Infect Dis. 1997; 24:487-93. [IDIS 382961] [PubMed 9114204]

20. Kishiyam JL, Adelman DC. The cross-reactivity and immunology of β-lactam antibiotics. Drug Safety. 1994; 10:318-27. [PubMed 8018304]

21. Thompson JW, Jacobs RF. Adverse effects of newer cephalosporins: an update. Drug Saf. 1993; 9:132-42. [PubMed 8397890]

22. Cook PJ, Andrews JM, Wise R et al. Distribution of cefdinir, a third generation cephalosporin antibiotic, in serum and pulmonary compartments. J Antimicrob Chemother. 1996; 37:331-9. [IDIS 364506] [PubMed 8707743]

23. Richer M, Allard S, Manseau L et al. Suction-induced blister fluid penetration of cefdinir in healthy volunteers following ascending oral doses. Antimicrob Agents Chemother. 1995; 39:1082-6. [IDIS 346312] [PubMed 7625793]

24. Tack KJ, Littlejohn TW, Mailloux G et al et al. Cefdinir versus cephalexin for the treatment of skin and skin-structure infections. Clin Ther. 1998; 20:244-56. [IDIS 405657] [PubMed 9589816]

25. Tack KJ, Henry DC, Gooch WM et al et al. Five-day cefdinir treatment for streptococcal pharyngitis. Antimicrob Agents Chemother. 1998; 42:1073-5. [IDIS 404900] [PubMed 9593129]

27. Guttendorf RJ, Misiak PM, Koup JR et al. Safety, tolerance, and pharmacokinetics of cefdinir (CI-983, FK-482) after single and multiple doses. In: American Society for Microbiology. Program and abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, IL; 1991:415. Abstract No. 1535.

28. Misiak P, Guttendorf R, Vassos A et al. Effect of high-fat meal on pharmacokinetics of cefdinir (CI-983, FK 482). In: American Society for Microbiology. Program and abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy. Anaheim, CA; 1992:271. Abstract No. 963.

29. Klein JO. Selection of oral antimicrobial agents for otitis media and pharyngitis. Infect Dis Clin Pract. 1995; 4(Suppl 2):S88-94.

30. Klein JO. Management of streptococcal pharyngitis. Pediatr Infect Dis J. 1994; 13:572-5. [IDIS 331902] [PubMed 8078757]

31. Pichichero ME. Cephalosporins are superior to penicillin for treatment of streptococcal tonsillopharyngitis: is the difference worth it? Pediatr Infect Dis. 1993; 12:268-74.

33. Aujard Y, Boucot I, Brahimi N et al. Comparative efficacy and safety of four-day cefuroxime axetil and ten-day penicillin treatment of group A beta-hemolytic streptococcal pharyngitis in children. Pediatr Infect Dis J. 1995; 14:295-300. [IDIS 345876] [PubMed 7603811]

34. Mehra S, Van Moerkerke M, Welck J et al. Short course therapy with cefuroxime axetil for group A streptococcal tonsillopharyngitis in children. Pediatr Infect Dis J. 1998; 17:452-7. [IDIS 408830] [PubMed 9655533]

35. Milatovic D. Evaluation of cefadroxil, penicillin and erythromycin in the treatment of streptococcal tonsillopharyngitis. Pediatr Infect Dis J. 1991; 10:S61-3. [PubMed 1945599]

37. Lieberthal AS, Carroll AE, Chonmaitree T et al. The diagnosis and management of acute otitis media. Pediatrics. 2013; 131:e964-99. [PubMed 23439909]

38. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: Twenty-first informational supplement. CLSI document M100-S21. Wayne, PA; 2011.

39. Mandell LA, Wunderink RG, Anzueto A et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 Suppl 2:S27-72. [PubMed 17278083]

40. Teva Pharmaceuticals. Cefdinir monohydrate powder for suspension prescribing information. Sellersville, PA; 2013 Jan.

41. Sandoz Inc. Cefdinir powder for suspension prescribing information. Princeton, NJ; 2011 Jul.

42. Cohen SH, Gerding DN, Johnson S et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010; 31:431-55. [PubMed 20307191]

43. Chow AW, Benninger MS, Brook I et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012; 54:e72-e112. [PubMed 22438350]

44. Wald ER, Applegate KE, Bordley C et al. Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years. Pediatrics. 2013; :. [PubMed 23796742]

a. AHFS Drug Information 2003. McEvoy GK, ed. Cephalosporins General Statement. Bethesda, MD: American Society of Health-System Pharmacists; 2003:125-39.

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