Prophylactic cefdinir for pediatric cases of complicated urinary tract infection.Cefdinir (Oral Route) Proper Use - Mayo Clinic
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Cefdinir: Pediatric drug information |
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Send the page " " to a friend, relative, colleague or yourself. We do not record any personal information entered above. Oral extended-spectrum, semisynthetic, third generation cephalosporin. It is not active against methicillin-resistant staphylococci or Pseudomonas aeruginosa. Cefdinir is used for skin infections and a variety of upper respiratory infections. Guidelines recommend cefdinir as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients.
Third-generation oral cephalosporins, such as cefdinir, are not recommended by the Infectious Disease Society of America IDSA for empiric monotherapy of acute bacterial sinusitis due to variable rates of S. Guidelines recommend cefdinir as an alternative to amoxicillin or amoxicillin; clavulanate for infections due to H. Guidelines do not recommend cefdinir for Group A Streptococcal pharyngitis to prevent rheumatic fever. Guidelines do not recommend cefdinir Group A Streptococcal pharyngitis to prevent rheumatic fever.
A 3- to 7-day course of cefidinir may be an alternative in patients with uncomplicated cystitis when other recommended agents cannot be used. Cefdinir has been shown to be statistically equivalent to cefaclor for microbiologic response rates and clinical cure rates in adults with uncomplicated urinary tract infection UTI. A treatment course of 7 to 14 days is recommended by the American Academy of Pediatrics AAP for the treatment of initial UTI in febrile infants and young children 2 to 24 months of age.
Shorter courses 2 to 4 days may be used in older children with uncomplicated cystitis. In a retrospective in vitro antimicrobial susceptibility study in children, This rate was comparable or superior to rates for other antibiotics i. Intermittent hemodialysis Hemodialysis removes cefdinir from the body. If antacids or iron supplements are necessary during cefdinir therapy, cefdinir should be given at least 2 hours before or after the antacid or iron supplement.
Iron-fortified infant formulas do not significantly alter the absorption of cefdinir. Cefdinir oral suspension may be administered without regard to meals. Shake well prior to each use. For accurate dosage, measure using a calibrated oral syringe, spoon or cup.
Suspension Reconstitution: Tap the bottle to loosen the powder. The water will be added in 2 portions; shake well after each aliquot. See manufacturer's specific instructions regarding reconstitution volumes needed. After mixing, the suspension can be stored at controlled room temperature. The container should be kept tightly closed when not in use. The suspension may be used for 10 days, after which any unused portion must be discarded.
Omnicef: - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F - Store in original container. A false-positive reaction for glucose in the urine has been observed in patients receiving cephalosporins, such as cefdinir, and using Benedict's solution, Fehling's solution, or Clinitest tablets for urine glucose testing.
However, this reaction has not been observed with glucose oxidase tests e. Patients with diabetes mellitus who test their urine for glucose should use glucose tests based on enzymatic glucose oxidase reactions while on cefdinir treatment. A positive direct Coombs test may develop in some patients. In hematologic studies or in transfusion cross-matching procedures when antiglobulin tests are performed on the minor side or in Coombs test of newborns whose mothers received cefdinir before delivery, clinicians should keep in mind that a positive Coombs test may be due to the drug.
Cefdinir does not treat viral infection e. Prescribing in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria antimicrobial resistance.
Patients should be told to complete the full course of treatment, even if they feel better earlier. Cefdinir is contraindicated in patients with a known history of cephalosporin hypersensitivity or cephamycin hypersensitivity.
Cefdinir should be used cautiously in patients with hypersensitivity to penicillin. The structural similarity between cefdinir and penicillin means cross-reactivity can occur. Penicillins can cause a variety of hypersensitivity reactions ranging from mild rash to fatal anaphylaxis. Patients who have experienced severe penicillin hypersensitivity should not receive cefdinir. Cefdinir should be used with caution in patients who have had a delayed-type reaction to penicillin or related drugs.
Serum sickness-like reactions have occurred following a second course of therapy. Because hemodialysis removes cefdinir from the body, additional dosage adjustments are needed to ensure therapeutic effect if a patient receives dialysis. Consider pseudomembranous colitis in patients presenting with diarrhea after antibacterial use. Careful medical history is necessary as pseudomembranous colitis has been reported to occur over 2 months after the administration of antibacterial agents. Almost all antibacterial agents, including cefdinir, have been associated with pseudomembranous colitis or C.
Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. All cephalosporins, including cefdinir, can rarely cause hypoprothrombinemia and have the potential to cause bleeding. Cephalosporins, which contain the methylthiotetrazole MTT side chain e.
Cephalosporins should be used cautiously in patients with a preexisting coagulopathy e. In patients with diabetes mellitus, it should be noted that cefdinir oral suspension contains sucrose 1. Safety and efficacy of cefdinir in neonates and infants less than 6 months of age have not been established. Cefdinir is classified in FDA pregnancy risk category B.
Animal data show that there are no teratogenic effects of cefdinir in rats. There are, however, no adequate and well-controlled studies in pregnant women, Because animal reproduction studies are not always predictive of human response, cefdinir should be used during pregnancy only if clearly needed.
Cefdinir may be administered to breast-feeding women. Cefdinir was not detected in human breast milk following single mg oral doses. Dose adjustment of cefdinir is not necessary in the geriatric patient unless renal function is markedly compromised. Clinical trial data and clinical experience suggests similar efficacy toin geriatric and younger adult patients. According to OBRA, use of antibiotics should be limited to confirmed or suspected bacterial infections.
Antibiotics are non-selective and may result in the eradication of beneficial microorganisms while promoting the emergence of undesired ones, causing secondary infections such as oral thrush, colitis, or vaginitis. Any antibiotic may cause diarrhea, nausea, vomiting, anorexia, and hypersensitivity reactions. Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: Moderate Administer cefdinir at least 2 hours before or 2 hours after magnesium salicylate. Cefdinir absorption may be reduced.
Antacids: Moderate Antacids containing magnesium or aluminum can interfere with the absorption of cefdinir. If aluminum or magnesium containing antacids are required during cefdinir therapy, cefdinir should be taken at least 2 hours before or after the antacid. Choline Salicylate; Magnesium Salicylate: Moderate Administer cefdinir at least 2 hours before or 2 hours after magnesium salicylate.
Desogestrel; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported.
It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs e. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use.
Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified.
During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries e.
Dienogest; Estradiol valerate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Drospirenone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Drospirenone; Estetrol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Drospirenone; Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Drospirenone; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Drospirenone; Ethinyl Estradiol; Levomefolate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Elagolix; Estradiol; Norethindrone acetate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Estradiol; Levonorgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Estradiol; Norethindrone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Estradiol; Norgestimate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Ethinyl Estradiol; Norelgestromin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Norethindrone Acetate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Ethinyl Estradiol; Norgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethynodiol Diacetate; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Etonogestrel; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.
Ferric Maltol: Moderate Administer cefdinir at least 2 hours before or 2 hours after iron supplements. Iron Salts: Moderate Administer cefdinir at least 2 hours before or 2 hours after iron supplements. Iron: Moderate Administer cefdinir at least 2 hours before or 2 hours after iron supplements.
In clinical trials, pediatric patients ( US and non-US) were treated with the recommended dose of cefdinir suspension (14 mg/kg/day). Most adverse. mg PO q12hr for days or mg PO q24hr for 10 days mg/day PO; CrCl <30 mL/min (children): 7 mg/kg PO q24hr; not to exceed mg/day. Dosing: Pediatric. General dosing: Infants, Children, and Adolescents: Oral: 14 mg/kg/day in divided doses every 12 to 24 hours; maximum daily dose: 7 mg/kg/dose PO every 12 hours or 14 mg/kg/dose PO every 24 hours. A treatment course of 7 to 14 days is recommended by the American Academy of Pediatrics (AAP). oral mg/kg dose produced no adverse effects. Toxic signs and symptoms CEFDINIR FOR ORAL SUSPENSION PEDIATRIC DOSAGE CHART. Weight. mg/5 mL. Diagn Microbiol Infect Dis. Iron-containing infant formulas do not appear alter cefdinir pharmacokinetics, but red-appearing, non-bloody stools may develop when combined. Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Cefdinir inhibits the third and final stage of bacterial cell wall synthesis by preferentially binding to specific penicillin-binding proteins PBPs that are located inside the bacterial cell wall. Clinical trial data and clinical experience suggests similar efficacy toin geriatric and younger adult patients. Required field.Bronchitis, chronic; acute bacterial exacerbation: Adolescents: Oral: mg every 12 hours for 5 to 10 days or mg every 24 hours for 10 days. Pneumonia, community-acquired alternative agent : Note: Cefdinir is not active against most strains of penicillin-resistant streptococci and is not approved for treatment of pneumonia caused by penicillin-nonsusceptible S.
Neither pediatric nor adult guidelines recommend cefdinir for patients with pneumonia due to known or suspected S. Adolescents: Oral: mg every 12 hours for 10 days Ref. Note: Durations as short as 5 days, depending on patient response, are recommended in adult community-acquired pneumonia guidelines for patients who are improving clinically Ref.
Rhinosinusitis, acute bacterial alternative agent for patients with penicillin allergy :. Note: The role of cefdinir in the management of acute bacterial sinusitis is limited; other options are preferred Ref. Adolescents: Oral: mg every 12 hours or mg every 24 hours for 10 days Ref. Skin and soft tissue infection, uncomplicated alternative agent : Note: Cefdinir is not currently recommended in IDSA guidelines for treatment of skin and soft tissue infection; alternate agents are preferred eg, first-generation cephalosporins.
Additionally, durations shorter than 10 days eg, 5 days may be appropriate for uncomplicated infections Ref. Preferred treatment duration is 10 days Ref , though 5 days may be adequate if cefdinir is dosed twice daily Ref. Adolescents: Oral: mg every 12 hours or mg every 24 hours Ref. Consult drug interactions database for more information. Subsequent doses should be administered every other day. There are no dosing adjustments provided in the manufacturer's labeling has not been studied.
For additional information see "Cefdinir: Drug information". Oral: mg twice daily or mg once daily for 5 to 7 days Ref. Odontogenic soft tissue infection, pyogenic initial therapy for mild infection or step-down therapy after parenteral treatment alternative agent off-label use :.
Note: For patients unable to take penicillin Ref. Oral: mg twice daily in combination with metronidazole; continue until clinical resolution, typically for 7 to 14 days. Otitis media, acute alternative agent for mild [nonanaphylactic] penicillin allergy : Limited data available: Oral: mg twice daily or mg once daily; duration of therapy is 5 to 7 days mild to moderate infection or 10 days severe infection Ref.
Rhinosinusitis, acute bacterial alternative agent for patients with penicillin allergy who are able to tolerate cephalosporins :. Note: In uncomplicated acute bacterial rhinosinusitis, initial observation and symptom management without antibiotic therapy is appropriate in most patients.
Reserve antibiotic therapy for poor follow-up or lack of improvement over the observation period Ref. Oral: mg twice daily with clindamycin for 5 to 7 days Ref ; some experts use as monotherapy when the risk of drug-resistant S. Streptococcal pharyngitis, group A alternative agent for mild, nonanaphylactic penicillin allergy :.
Note: Cephalosporin selection depends on the type of hypersensitivity reaction to penicillin. To avoid the development of resistance, narrower spectrum cephalosporins eg, cephalexin or cefadroxil are preferred when possible Ref.
Oral: mg twice daily for 5 to 10 days or mg once daily for 10 days Ref. Urinary tract infection alternative agent off-label use : Note: Use only when first-line agents cannot be used; limited evidence suggests inferior efficacy of oral beta-lactams Ref.
Urinary tract infection, complicated including pyelonephritis : Oral: mg twice daily for 10 to 14 days. Note: Oral beta-lactam therapy should generally follow appropriate parenteral therapy Ref.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Altered kidney function Ref : Oral:.
Note: Limited pharmacokinetic data have demonstrated prolonged half-lives and increased serum concentrations in patients undergoing intermittent hemodialysis Ref. Peritoneal dialysis: Slightly dialyzable Ref :. Note: Limited pharmacokinetic data have demonstrated prolonged half-lives and increased serum concentrations in patients undergoing peritoneal dialysis Ref. Oral: mg every 48 hours Ref. CRRT: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement.
Appropriate dosing requires consideration of adequate drug concentrations eg, site of infection. Close monitoring of response and adverse reactions due to drug accumulation is important. Oral: mg every 12 hours Ref. Note: In general, use of IV antimicrobial therapy or alternative oral therapies with greater bioavailability may be preferred in patients receiving CRRT Ref.
PIRRT eg, sustained, low-efficiency diafiltration : Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Excipient information presented when available limited, particularly for generics ; consult specific product labeling. Oral: May administer with or without food; administer with food if stomach upset occurs; administer cefdinir at least 2 hours before or after antacids or iron supplements; shake suspension well before use.
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.
GI effects range from antibiotic-associated [non— Clostridioides difficile ] diarrhea AAD , nausea , and vomiting. Most cases of AAD are mild and self-limiting. Mechanism : Dose- and time-related; antibiotic disruption of indigenous gut microbiota Ref.
Onset : Varied; mean time to onset of AAD is 3 to 18 days for adult patients and 2 to 6 days for pediatric patients. The majority of AAD cases occur during versus after antibiotic therapy in pediatric patients Ref. Mechanism : Dose- and time-related; related to cumulative antibiotic exposure. Cefdinir may cause disruption of the intestinal microbiota resulting in the overgrowth of pathogens, such as C. Onset : Varied; may start on the first day of antibiotic therapy or up to 3 months postantibiotic Ref.
Hypersensitivity reactions immediate and delayed range from skin rash to rare cases of anaphylaxis. Severe cutaneous adverse reactions SCARs , including Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported. Mechanism: Non—dose-related; immunologic. Immediate hypersensitivity reactions eg, anaphylaxis, urticaria are IgE-mediated.
Onset: Immediate hypersensitivity reactions: Rapid; occur within 1 hour of administration but may occur up to 6 hours after exposure Ref. Delayed hypersensitivity reactions: Maculopapular reactions: Intermediate; occur 7 to 10 days after initiation. A meta-analysis showed negligible cross-reactivity between penicillins and third-generation cephalosporins, such as cefdinir Ref. The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Dermatologic: Cutaneous candidiasis, maculopapular rash, pruritus. Gastrointestinal: Anorexia, constipation, dyspepsia, flatulence, xerostomia. Hepatic: Increased serum alanine aminotransferase, increased serum aspartate aminotransferase, increased serum bilirubin.
Renal: Decreased urine specific gravity, increased blood urea nitrogen, increased urine pH, increased urine specific gravity. Cardiovascular: Acute myocardial infarction, cardiac failure, chest pain, hypersensitivity angiitis, hypertension, shock. Dermatologic: Erythema multiforme, erythema nodosum, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
Gastrointestinal: Acute enterocolitis, bloody diarrhea, cholestasis, Clostridioides difficile associated diarrhea Lv , Clostridioides difficile colitis, hemorrhagic colitis, intestinal obstruction, melena, peptic ulcer, stomatitis.
Hepatic: Fulminant hepatitis, hepatic failure, hepatitis acute , jaundice. Nervous system: Involuntary body movements, loss of consciousness. Respiratory: Acute respiratory failure, eosinophilic pneumonitis, idiopathic interstitial pneumonitis, laryngeal edema, pneumonia drug-induced , respiratory distress feeling of suffocation , status asthmaticus.
Hypersensitivity to cefdinir, any component of the formulation, or other cephalosporins. Concerns related to adverse effects:. Disease-related concerns:. Concurrent drug therapy issues:. For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program.
Aminoglycosides: Cephalosporins may enhance the nephrotoxic effect of Aminoglycosides. Cephalosporins may decrease the serum concentration of Aminoglycosides. Risk C: Monitor therapy. Antacids: May decrease the absorption of Cefdinir. Management: Administer cefdinir 2 hours before or 2 hours after aluminum- or magnesium-containing antacids. Risk D: Consider therapy modification. Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii.
Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk X: Avoid combination.
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. Furosemide: May enhance the nephrotoxic effect of Cephalosporins. Iron Preparations: 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. Separate doses by at least 2 hours if combined. Iron-containing infant formulas do not appear alter cefdinir pharmacokinetics, but red-appearing, non-bloody stools may develop when combined.
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol.
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