Cefdinir for Streptococcal Pharyngitis

First-Line Treatment Options

• The American Academy of Pediatrics and the Infectious Diseases Society of America recommend penicillin or amoxicillin as the treatment of choice for Group A Streptococcal (GAS) pharyngitis due to their proven efficacy, safety, narrow spectrum, and low cost 1
• The Centers for Disease Control and Prevention note that penicillin-resistant GAS has never been documented anywhere in the world, making penicillin a highly reliable option 1, 2
• The American Academy of Pediatrics suggests that amoxicillin once daily (50 mg/kg, maximum 1000 mg) for 10 days is equally effective as other regimens and may enhance adherence due to once-daily dosing 1

Role of Cefdinir in Streptococcal Pharyngitis

• The Infectious Diseases Society of America recommends cefdinir as a second-line treatment option for streptococcal pharyngitis in penicillin-allergic patients, but not as first-line therapy due to its broader spectrum and higher cost compared to penicillin or amoxicillin 1

Appropriate Use of Cefdinir

• The American Academy of Otolaryngology-Head and Neck Surgery suggests considering cefdinir for patients with non-anaphylactic penicillin allergy 1, 2
• The Infectious Diseases Society of America recommends considering cefdinir when first-line treatment has failed 3
• The American Academy of Otolaryngology-Head and Neck Surgery notes that cefdinir may be considered in areas with high prevalence of β-lactamase producing organisms 4

Important Considerations and Limitations

• The Centers for Disease Control and Prevention warn that cephalosporins like cefdinir have a broader antimicrobial spectrum than needed for streptococcal pharyngitis, which increases the risk of selecting for antibiotic-resistant flora 2
• The American Academy of Allergy, Asthma, and Immunology notes that up to 10% of penicillin-allergic persons are also allergic to cephalosporins, and cefdinir should not be used in patients with immediate (anaphylactic-type) hypersensitivity to penicillin 2
• The Infectious Diseases Society of America notes that cefdinir is more expensive than penicillin or amoxicillin 1
• The American Academy of Pediatrics reports that macrolide resistance among GAS isolates in the US is approximately 5-8%, making macrolides less reliable alternatives than cephalosporins for penicillin-allergic patients 3

Treatment Algorithm for Streptococcal Pharyngitis

• The Infectious Diseases Society of America recommends the following treatment algorithm: