Medically reviewed on Nov 15, 2018
(SEF di ner)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Generic: 300 mg
Suspension Reconstituted, Oral:
Generic: 125 mg/5 mL (60 mL, 100 mL); 250 mg/5 mL (60 mL, 100 mL)
- Antibiotic, Cephalosporin (Third Generation)
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.
Penetrates into blister fluid, middle ear fluid, tonsils, sinus, and lung tissues. Vd: Children 6 months to 12 years: 0.67 ± 0.38 L/kg; Adults: 0.35 ± 0.29 L/kg
Primarily urine (~12% to 18% as unchanged drug)
Time to Peak
2 to 4 hours
1.7 (± 0.6) hours with normal renal function
60% to 70%
Special Populations: Renal Function Impairment
Clearance is reduced.
Use: Labeled Indications
Chronic obstructive pulmonary disease, exacerbation (uncomplicated): Treatment of acute exacerbations of chronic bronchitis in adults and adolescents caused by Haemophilus influenzae (including beta-lactamase-producing strains), Haemophilus parainfluenzae (including beta-lactamase-producing strains), Streptococcus pneumoniae (penicillin-susceptible strains only), and Moraxella catarrhalis (including beta-lactamase-producing strains)
Otitis media, acute bacterial: Treatment of acute bacterial otitis media in pediatric patients caused by H. influenzae (including beta-lactamase-producing strains), S. pneumoniae (penicillin-susceptible strains only), and M. catarrhalis (including beta-lactamase-producing strains)
Pneumonia, community-acquired: Treatment of community-acquired pneumonia in adults and adolescents caused by H. influenzae (including beta-lactamase-producing strains), H. parainfluenzae (including beta-lactamase-producing strains), S. pneumoniae (penicillin-susceptible strains only), and M. catarrhalis (including beta-lactamase-producing strains)
Sinusitis, acute: Treatment of acute maxillary sinusitis in adults and adolescents caused by H. influenzae (including beta-lactamase-producing strains), S. pneumoniae (penicillin-susceptible strains only), and M. catarrhalis (including beta-lactamase-producing strains). Note: Limitations of use: According to the IDSA guidelines for acute bacterial rhinosinusitis, cefdinir is no longer recommended as monotherapy for initial empiric treatment (IDSA [Chow 2012]).
Skin and skin structure infections, uncomplicated: Treatment of uncomplicated skin and skin structure infections in adults, adolescents, and pediatric patients caused by Staphylococcus aureus (including beta-lactamase-producing strains) and Streptococcus pyogenes
Streptococcal pharyngitis (group A): Treatment of pharyngitis/tonsillitis in adults, adolescents, and pediatric patients caused by S. pyogenes
Off Label Uses
Urinary tract infection, complicated (including pyelonephritis)
Clinical experience suggests the utility of cefdinir as an alternative agent in the treatment of acute complicated UTI (including pyelonephritis) after administration of an appropriate parenteral agent [Hooton 2018a].
Urinary tract infection, cystitis (acute uncomplicated or acute simple)
Clinical experience suggests the utility of cefdinir as an alternative agent in the treatment of acute simple cystitis (infection limited to the bladder and no signs/symptoms of upper tract or systemic infections) [Hooton 2018b], [Hooton 2018c].
Based on the Infectious Diseases Society of America and European Society for Microbiology and Infectious Diseases (IDSA/ESCMID) international clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women, cefdinir is an effective and recommended alternative agent in the management of acute uncomplicated cystitis [ESMID/IDSA [Gupta 2011]].
Hypersensitivity to cefdinir, any component of the formulation, or other cephalosporins.
Chronic obstructive pulmonary disease, exacerbation (uncomplicated): Oral: 300 mg twice daily or 600 mg once daily for 5 to 7 days (Bartlett 2018; GOLD 2018)
Ear, nose, and throat infections:
Otitis media, acute (alternative agent for mild [non-anaphylactic] penicillin allergy): Limited data available: Oral: 300 mg twice daily or 600 mg once daily; duration of therapy is 5 to 7 days (mild to moderate infection) or 10 days (severe infection) (Limb 2018; manufacturer's labeling)
Streptococcal pharyngitis (group A) (alternative agent for mild [non-anaphylactic] penicillin allergy): Oral: 300 mg twice daily for 5 to 10 days or 600 mg once daily for 10 days (Pichichero 2018; manufacturer's labeling)
Pneumonia, community-acquired, pathogen-directed therapy for Streptococcus pneumoniae (alternative agent): Note: Cefdinir should only be used for treatment of community-acquired pneumonia due to S. pneumoniae if the penicillin MIC is <2 mcg/mL (IDSA/ATS [Mandell 2007]).
Oral: 300 mg twice daily (manufacturer's labeling). Duration is for a minimum of 5 days; patients should be afebrile for ≥48 hours and clinically stable before therapy is discontinued (IDSA/ATS [Mandell 2007]).
UTI (alternative agent) (off-label use): Note: Although evidence is limited, some experts recommend the use of cefdinir in this setting. Use with caution and only when preferred agents cannot be used (due to decreased efficacy of oral beta-lactams compared to other agents) (IDSA/ESCMID [Gupta 2011]; Hooton 2018a; Hooton 2018b; Hooton 2018c). Closely monitor patient.
Acute uncomplicated cystitis or acute simple cystitis (infection limited to bladder and no signs/symptoms of upper tract of systemic infection): Oral: 300 mg twice daily for 5 to 7 days (IDSA/ESCMID [Gupta 2011]; Hooton 2018b; Hooton 2018c)
UTI, complicated, including pyelonephritis: Oral: 300 mg twice daily for 10 to 14 days. Note: Oral therapy should follow appropriate parenteral therapy. For outpatient treatment of mild infection, a single dose of a long-acting parenteral agent is acceptable; for outpatients who are more ill or are at risk for more severe illness, consider continuing parenteral therapy until culture and susceptibility results are available (IDSA/ESCMID [Gupta 2011]; Hooton 2018a).
Refer to adult dosing.
Infants ≥6 months and Children:
Acute bacterial otitis media, pharyngitis/tonsillitis: Oral: 7 mg/kg/dose twice daily for 5 to 10 days or 14 mg/kg/dose once daily for 10 days (maximum: 600 mg/day)
Acute maxillary sinusitis: Oral: 7 mg/kg/dose twice daily or 14 mg/kg/dose once daily for 10 days (maximum: 600 mg/day). Note: According to the IDSA guidelines for acute bacterial rhinosinusitis, cefdinir is no longer recommended as monotherapy for initial empiric treatment (Chow, 2012).
Uncomplicated skin and skin structure infections: Oral: 7 mg/kg/dose twice daily for 10 days (maximum: 600 mg/day)
Adolescents: Refer to adult dosing.
Dosing: Renal Impairment
CrCl ≥30 mL/minute: No dosage adjustment necessary.
CrCl <30 mL/minute:
Adolescents and Adults: 300 mg once daily
Infants ≥6 months and Children: 7 mg/kg once daily (maximum: 300 mg/day)
ESRD requiring intermittent hemodialysis (IHD): Dialyzable: (63%): Initial dose: 300 mg (or 7 mg/kg/dose) every other day. Postdialysis, 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.
Dosing: Hepatic Impairment
No dosage adjustment necessary.
Refer to manufacturer’s product labeling for reconstitution instructions.
Oral: Twice daily doses should be given every 12 hours. May be administered with or without food. Manufacturer recommends administering at least 2 hours before or after antacids or iron supplements. Shake suspension well before use.
Store at 20°C to 25°C (68°F to 77°F). Store reconstituted suspension at room temperature 20°C to 25°C (68°F to 77°F) for 10 days.
Aminoglycosides: Cephalosporins (3rd Generation) may enhance the nephrotoxic effect of Aminoglycosides. Monitor therapy
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Avoid combination
Iron Salts: May decrease the serum concentration of Cefdinir. Red-appearing, non-bloody stools may also develop due to the formation of an insoluble iron-cefdinir complex. Management: Avoid concurrent cefdinir and oral iron when possible. Separating doses by several hours may minimize interaction. Iron-containing infant formulas do not appear to interact with cefdinir. Exceptions: Ferric Carboxymaltose; Ferric Gluconate; Ferric Hydroxide Polymaltose Complex; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Isomaltoside; Iron Sucrose. Consider therapy modification
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy
Multivitamins/Minerals (with ADEK, Folate, Iron): May decrease the serum concentration of Cefdinir. Specifically, Iron Salts may decrease the serum concentration of Cefdinir. Red-appearing, non-bloody stools may also develop due to the formation of an insoluble iron-cefdinir complex. Management: Avoid concurrent cefdinir and oral iron-containing multivitamins when possible. Separating doses by several hours may minimize interaction. Iron-containing infant formulas do not appear to interact with cefdinir. Consider therapy modification
Probenecid: May increase the serum concentration of Cephalosporins. Monitor therapy
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents. Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Monitor therapy
False-positive reaction for urinary ketones may occur with nitroprusside- but not nitroferricyanide-based tests. False-positive urine glucose results may occur when using Clinitest®, Benedict's solution, or Fehling’s solution; glucose-oxidase-based reaction systems (eg, Clinistix®, Tes-Tape®) are recommended. May cause positive direct Coombs’ test.
>10%: Gastrointestinal: Diarrhea (8% to 15%)
1% to 10%:
Central nervous system: Headache (2%)
Dermatologic: Skin rash (≤3%)
Endocrine & metabolic: Decreased serum bicarbonate (≤1%), glycosuria (≤1%), hyperglycemia (≤1%), hyperphosphatemia (≤1%), increased gamma-glutamyl transferase (≤1%), increased lactate dehydrogenase (≤1%)
Gastrointestinal: Nausea (≤3%), abdominal pain (≤1%), vomiting (≤1%)
Genitourinary: Vulvovaginal candidiasis (≤4%), urine abnormality (increased leukocytes: ≤2%), proteinuria (1% to 2%), occult blood in urine (≤1%), vaginitis (≤1%)
Hematologic & oncologic: Lymphocytosis (≤2%), eosinophilia (1%), lymphocytopenia (1%), abnormal neutrophils (functional disorder of polymorphonuclear neutrophils: ≤1%), thrombocythemia (≤1%), change in WBC count (≤1%)
Hepatic: Increased serum alkaline phosphatase (≤1%), increased serum ALT (≤1%)
Renal: Increased urine pH (≤1%), increased urine specific gravity (≤1%)
<1%, postmarketing, and/or case reports: Abnormal stools, anaphylaxis, anorexia, asthma, blood coagulation disorder, bloody diarrhea, candidiasis, cardiac failure, chest pain, cholestasis, conjunctivitis, constipation, cutaneous candidiasis, decreased hemoglobin, decreased urine specific gravity, disseminated intravascular coagulation, dizziness, drowsiness, dyspepsia, enterocolitis (acute), eosinophilic pneumonitis, erythema multiforme, erythema nodosum, exfoliative dermatitis, facial edema, fever, flatulence, fulminant hepatitis, granulocytopenia, hemolytic anemia, hemorrhagic colitis, hemorrhagic diathesis, hepatic failure, hepatitis (acute), hyperkalemia, hyperkinesia, hypersensitivity angiitis, hypertension, hypocalcemia, hypophosphatemia, immune thrombocytopenia, increased amylase, increased blood urea nitrogen, increased monocytes, increased serum AST, increased serum bilirubin, insomnia, interstitial pneumonitis (idiopathic), intestinal obstruction, involuntary body movements, jaundice, laryngeal edema, leukopenia, leukorrhea, loss of consciousness, maculopapular rash, melena, myocardial infarction, pancytopenia, peptic ulcer, pneumonia (drug-induced), pruritus, pseudomembranous colitis, renal disease, renal failure (acute), respiratory failure (acute), rhabdomyolysis, serum sickness, shock, Stevens-Johnson syndrome, stomatitis, thrombocytopenia, toxic epidermal necrolysis, upper gastrointestinal hemorrhage, weakness, xerostomia
Concerns related to adverse effects:
• Penicillin allergy: Use with caution in patients with a history of penicillin allergy, especially IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria).
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
• Colitis: Use with caution in patients with a history of colitis.
• Renal impairment: Use with caution in patients with renal impairment (CrCl <30 mL/minute); dosage adjustment may be required.
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
• Iron-containing products: Cases of reddish stools have been reported with concomitant use of cefdinir and iron-containing products due to the formation of a nonabsorbable complex in the GI tract.
Monitor renal function. Observe for signs and symptoms of anaphylaxis during first dose.
Pregnancy Risk Factor
Teratogenic events have not been observed in animal reproduction studies. An increase in most types of birth defects was not found following first trimester exposure to cephalosporins.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience diarrhea. Have patient report immediately to prescriber bruising, bleeding, urinary retention, change in amount of urine passed, chills, pharyngitis, severe loss of strength and energy, seizures, vaginitis, or signs of Clostridium difficile (C. diff)-associated diarrhea (abdominal pain or cramps, severe diarrhea or watery stools, or bloody stools) (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
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More about cefdinir
- Cefdinir Side Effects
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- Drug class: third generation cephalosporins
Other brands: Omnicef