- Cefdinir Side Effects
- In Summary
- For the Consumer
- For Healthcare Professionals
- Further information
- More about cefdinir
- SIDE EFFECTS
- Brand Names: Canada
- What is this drug used for?
- What do I need to tell my doctor BEFORE I take this drug?
- What are some things I need to know or do while I take this drug?
- What are some side effects that I need to call my doctor about right away?
- What are some other side effects of this drug?
- How is this drug best taken?
- What do I do if I miss a dose?
- How do I store and/or throw out this drug?
- General drug facts
- Consumer Information Use and Disclaimer
- Last Reviewed Date
- New Guidelines Recommend Cefdinir as First-Line Treatment for Acute Bacterial Sinusitis
- 10 Tips About Cefdinir for UTI
- #1 Cefdinir or Keflex for UTI?
- #2 Do Not Use Cefdinir For An Uncomplicated UTI
- #3 Plan A Hospital Stay, If Cefdinir Doesn’t Work
- #4 Cefdinir Is Not Approved By FDA For UTI
- #5 Cefdinir And Your Microbiome
- #6 Keep In Mind
- #7 Cefdinir For UTI: Side Effects
- #8 Cefdinir Could Cause C. diff Colitis
- #9 How To Boost Performance Of Cefdinir For UTI
- #10 Recover After Cefdinir: Probiotics
- Antibiotics and Sinusitis
- What are antibiotics?
- When should antibiotics be used?
- Why will my doctor not prescribe antibiotics over the phone?
- What is antibiotic resistance?
- What are the most common antibiotics used for sinusitis?
Cefdinir Side Effects
Medically reviewed by Drugs.com. Last updated on Jan 3, 2019.
- Side Effects
Commonly reported side effects of cefdinir include: diarrhea. See below for a comprehensive list of adverse effects.
For the Consumer
Applies to cefdinir: oral capsule, oral powder for suspension
Along with its needed effects, cefdinir may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking cefdinir:
- Black, tarry stools
- chest pain
- painful or difficult urination
- shortness of breath
- sore throat
- sores, ulcers, or white spots on the lips or in the mouth
- swollen glands
- unusual bleeding or bruising
- unusual tiredness or weakness
Incidence not known
- Abdominal or stomach cramps or tenderness
- back, leg, or stomach pains
- bleeding gums
- blistering, peeling, or loosening of the skin
- blood in the urine or stools
- bloody nose
- bloody or cloudy urine
- bloody, black, or tarry stools
- blue lips, fingernails, or skin
- chest pain or discomfort
- clay-colored stools
- cold, clammy skin
- coughing or vomiting blood
- cracks in the skin
- dark-colored urine
- diarrhea, watery and severe, which may also be bloody
- difficult or troubled breathing
- difficulty with breathing or swallowing
- dilated neck veins
- extreme fatigue
- fast heartbeat
- fast, weak pulse
- feeling of discomfort
- general body swelling
- general tiredness and weakness
- heavier menstrual periods
- high fever
- increased thirst
- inflammation of the joints
- irregular breathing
- irregular heartbeat
- irregular, fast or slow, or shallow breathing
- joint or muscle pain
- light-colored stools
- loss of appetite
- loss of consciousness
- loss of heat from the body
- muscle aches
- muscle cramps or spasms
- muscle pain or stiffness
- nausea or vomiting
- noisy breathing
- pain in the ankles or knees
- pain or discomfort in the arms, jaw, back, or neck
- painful, red lumps under the skin, mostly on the legs
- pale skin
- persistent bleeding or oozing from puncture sites, mouth, or nose
- pinpoint red spots on the skin
- problems with bleeding or clotting
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- red skin lesions, often with a purple center
- red, irritated eyes
- red, swollen skin
- scaly skin
- severe stomach pain
- slow or irregular breathing
- sudden decrease in the amount of urine
- swelling of the face, fingers, feet, or lower legs
- swollen lymph glands
- tightness in the chest
- unpleasant breath odor
- unusual weight loss
- upper right abdominal or stomach pain
- vomiting of blood
- weight gain
- yellow eyes or skin
Some side effects of cefdinir may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Itching of the vagina or genital area
- pain during sexual intercourse
- thick, white vaginal discharge with no odor or with a mild odor
- vaginal yeast infection
- Acid or sour stomach
- dry mouth
- excess air or gas in the stomach or intestines
- full feeling
- increase in body movements
- increased clear or white vaginal discharge
- lack or loss of strength
- passing gas
- rash with flat lesions or small raised lesions on the skin
- sleepiness or unusual drowsiness
- soreness or redness around the fingernails and toenails
- stomach discomfort, upset, or pain
- unable to sleep
Incidence not known
- Burning, dry, or itching eyes
- discharge, excessive tearing
- redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
- swelling or inflammation of the mouth
For Healthcare Professionals
Applies to cefdinir: oral capsule, oral powder for reconstitution
Reddish-colored stools have occurred when cefdinir was taken with iron-containing products, and may be due to the formation of non-absorbable complexes in the GI tract.
Hypersensitivity reactions associated with cephalosporin class antibiotics have included allergic reactions, anaphylaxis, Stevens-Johnson syndrome, erythema multiforme, and toxic epidermal necrolysis. Adverse effects reported during postmarketing experience with cefdinir, regardless of causality, have included anaphylaxis (with rare cases of fatality), serum sickness-like reactions, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
Dermatologic side effects have included rash (0.9%) and pruritus (0.2%). Adverse effects reported during postmarketing experience with cefdinir, regardless of causality, have included exfoliative dermatitis, erythema multiforme, and erythema nodosum.
Hematologic side effects have included increased lymphocytes (1%), decreased lymphocytes (0.2%), increased white blood cells (0.9%), decreased white blood cells (0.7%), increased eosinophils (0.7%), decreased hemoglobin (0.3%), increased polymorphonuclear neutrophils (0.3%), decreased polymorphonuclear neutrophils (0.2%), and increased platelets (0.2%). Adverse effects reported during postmarketing experience with cefdinir, regardless of causality, have included granulocytopenia, pancytopenia, leukopenia, thrombocytopenia, idiopathic thrombocytopenic purpura, hemolytic anemia, bleeding tendency, coagulation disorder, and disseminated intravascular coagulation. Cephalosporins as a class have been associated with aplastic anemia, hemolytic anemia, prolonged prothrombin time, hemorrhage, neutropenia, pancytopenia, and agranulocytosis.
Hepatic side effects associated with cephalosporins as a class have included hepatic dysfunction, including cholestasis. Adverse effects reported during postmarketing experience with cefdinir, regardless of causality, have included acute hepatitis, cholestasis, fulminant hepatitis, hepatic failure, jaundice, and increased amylase.
Renal side effects associated with cephalosporins as a class have included renal dysfunction and toxic nephropathy. Adverse effects reported during postmarketing experience with cefdinir, regardless of causality, have included acute renal failure and nephropathy.
Ocular adverse effects reported during postmarketing experience with cefdinir, regardless of causality, have included conjunctivitis.
Respiratory adverse effects reported during postmarketing experience with cefdinir, regardless of causality, have included acute respiratory failure, asthmatic attack, drug-induced pneumonia, eosinophilic pneumonia, and idiopathic interstitial pneumonia.
Adverse effects reported during postmarketing experience with cefdinir, regardless of causality, have included fever, shock, feeling of suffocation, and facial and laryngeal edema.
Cardiovascular adverse effects reported during postmarketing experience with cefdinir, regardless of causality, have included cardiac failure, chest pain, myocardial infarction, hypertension, and allergic vasculitis.
Musculoskeletal adverse effects reported during postmarketing experience with cefdinir, regardless of causality, have included involuntary movements and rhabdomyolysis.
Geriatric patients have been reported to experience a lower rate of adverse events, including diarrhea, than younger patients.
1. Tack KJ, Keyserling CH, McCarty J, Hedrick JA “Study of use of cefdinir versus cephalexin for treatment of skin infections in pediatric patients. The Cefdinir Pediatric Ski Infection Study Group.” Antimicrob Agents Chemother 41 (1997): 739-42
3. Tack KJ, Hedrick JA, Rothstein E, Nemeth MA, Keyserling C, Pichichero ME “A study of 5-day cefdinir treatment for streptococcal pharyngitis in children. Cefdinir Pediatric Pharyngitis Study Group.” Arch Pediatr Adolesc Med 151 (1997): 45-9
4. Tack KJ, Littlejohn TW, Mailloux G, Wolf MM, Keyserling CH “Cefdinir versus cephalexin for the treatment of skin and skin-structure infections.” Clin Ther 20 (1998): 244-56
5. Kato S, Ebina K, Ozawa A, Naganuma H, Nakagawa H “Antibiotic-associated hemorrhagic colitis without Clostridium difficile toxin in children.” J Pediatr 126 (1995): 1008-10
6. “Product Information. Omnicef (cefdinir).” Parke-Davis, Morris Plains, NJ.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Some side effects may not be reported. You may report them to the FDA.
- Cefdinir – Can a capsule be broken open and sprinkled on food?
More about cefdinir
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- En Español
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- Drug class: third generation cephalosporins
- Cefdinir Capsules
- Cefdinir Suspension
- Cefdinir (Advanced Reading)
Other brands: Omnicef, Omnicef Omni-Pac
- Cefdinir (AHFS Monograph)
- … +3 more
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Clinical Trials – OMNICEF Capsules (Adult and Adolescent Patients)
In clinical trials, 5093 adult and adolescent patients (3841 US and 1252 non-US) were treated with the recommended dose of cefdinir capsules (600 mg/day). Most adverse events were mild and self-limiting. No deaths or permanent disabilities were attributed to cefdinir. One hundred forty-seven of 5093 (3%) patients discontinued medication due to adverse events thought by the investigators to be possibly, probably, or definitely associated with cefdinir therapy. The discontinuations were primarily for gastrointestinal disturbances, usually diarrhea or nausea. Nineteen of 5093 (0.4%) patients were discontinued due to rash thought related to cefdinir administration.
In the US, the following adverse events were thought by investigators to be possibly, probably, or definitely related to cefdinir capsules in multiple-dose clinical trials (N = 3841 cefdinir-treated patients):
ADVERSE EVENTS ASSOCIATED WITH CEFDINIR CAPSULES US TRIALS IN ADULT AND ADOLESCENT PATIENTS (N = 3841)a
The following laboratory value changes of possible clinical significance, irrespective of relationship to therapy with cefdinir, were seen during clinical trials conducted in the US:
LABORATORY VALUE CHANGES OBSERVED WITH CEFDINIR CAPSULES US TRIALS IN ADULT AND ADOLESCENT PATIENTS (N = 3841)
Clinical Trials – OMNICEF For Oral Suspension (Pediatric Patients)
In clinical trials, 2289 pediatric patients (1783 US and 506 non-US) were treated with the recommended dose of cefdinir suspension (14 mg/kg/day). Most adverse events were mild and self-limiting. No deaths or permanent disabilities were attributed to cefdinir. Forty of 2289 (2%) patients discontinued medication due to adverse events considered by the investigators to be possibly, probably, or definitely associated with cefdinir therapy. Discontinuations were primarily for gastrointestinal disturbances, usually diarrhea. Five of 2289 (0.2%) patients were discontinued due to rash thought related to cefdinir administration.
In the US, the following adverse events were thought by investigators to be possibly, probably, or definitely related to cefdinir suspension in multiple-dose clinical trials (N = 1783 cefdinirtreated patients):
ADVERSE EVENTS ASSOCIATED WITH CEFDINIR SUSPENSION US TRIALS IN PEDIATRIC PATIENTS (N = 1783)a
NOTE: In both cefdinir- and control-treated patients, rates of diarrhea and rash were higher in the youngest pediatric patients. The incidence of diarrhea in cefdinir-treated patients ≤ 2 years of age was 17% (95/557) compared with 4% (51/1226) in those > 2 years old. The incidence of rash (primarily diaper rash in the younger patients) was 8% (43/557) in patients ≤ 2 years of age compared with 1% (8/1226) in those > 2 years old.
The following laboratory value changes of possible clinical significance, irrespective of relationship to therapy with cefdinir, were seen during clinical trials conducted in the US:
LABORATORY VALUE CHANGES OF POSSIBLE CLINICAL SIGNIFICANCE OBSERVED WITH CEFDINIR SUSPENSION US TRIALS IN PEDIATRIC PATIENTS (N = 1783)
The following adverse experiences and altered laboratory tests, regardless of their relationship to cefdinir, have been reported during extensive postmarketing experience, beginning with approval in Japan in 1991: shock, anaphylaxis with rare cases of fatality, facial and laryngeal edema, feeling of suffocation, serum sickness-like reactions, conjunctivitis, stomatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, erythema nodosum, acute hepatitis, cholestasis, fulminant hepatitis, hepatic failure, jaundice, increased amylase, acute enterocolitis, bloody diarrhea, hemorrhagic colitis, melena, pseudomembranous colitis, pancytopenia, granulocytopenia, leukopenia, thrombocytopenia, idiopathic thrombocytopenic purpura, hemolytic anemia, acute respiratory failure, asthmatic attack, drug-induced pneumonia, eosinophilic pneumonia, idiopathic interstitial pneumonia, fever, acute renal failure, nephropathy, bleeding tendency, coagulation disorder, disseminated intravascular coagulation, upper GI bleed, peptic ulcer, ileus, loss of consciousness, allergic vasculitis, possible cefdinir-diclofenac interaction, cardiac failure, chest pain, myocardial infarction, hypertension, involuntary movements, and rhabdomyolysis.
Cephalosporin Class Adverse Events
The following adverse events and altered laboratory tests have been reported for cephalosporinclass antibiotics in general:
Allergic reactions, anaphylaxis, Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, renal dysfunction, toxic nephropathy, hepatic dysfunction including cholestasis, aplastic anemia, hemolytic anemia, hemorrhage, false-positive test for urinary glucose, neutropenia, pancytopenia, and agranulocytosis. Pseudomembranous colitis symptoms may begin during or after antibiotic treatment (see WARNINGS).
Several cephalosporins have been implicated in triggering seizures, particularly in patients with renal impairment when the dosage was not reduced (see DOSAGE AND ADMINISTRATION and OVERDOSAGE). If seizures associated with drug therapy occur, the drug should be discontinued. Anticonvulsant therapy can be given if clinically indicated.
Read the entire FDA prescribing information for Omnicef (Cefdinir)
This information from Lexicomp® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider.
Brand Names: Canada
What is this drug used for?
- It is used to treat bacterial infections.
What do I need to tell my doctor BEFORE I take this drug?
- If you have an allergy to cefdinir or any other part of this drug.
- If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.
This drug may interact with other drugs or health problems.
Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
What are some things I need to know or do while I take this drug?
- Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
- Do not use longer than you have been told. A second infection may happen.
- If you have high blood sugar (diabetes) and test your urine glucose, talk with your doctor to find out which tests are best to use.
- If you have high blood sugar (diabetes), talk with the doctor. Some of these products have sugar.
- This drug may affect certain lab tests. Tell all of your health care providers and lab workers that you take this drug.
- If you take this drug with an iron product, your stools may turn a reddish color. This is normal.
- Tell your doctor if you are pregnant, plan on getting pregnant, or are breast-feeding. You will need to talk about the benefits and risks to you and the baby.
What are some side effects that I need to call my doctor about right away?
WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
- Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
- Not able to pass urine or change in how much urine is passed.
- Dark urine or yellow skin or eyes.
- Fever, chills, or sore throat; any unexplained bruising or bleeding; or feeling very tired or weak.
- Diarrhea is common with antibiotics. Rarely, a severe form called C diff–associated diarrhea (CDAD) may happen. Sometimes, this has led to a deadly bowel problem (colitis). CDAD may happen during or a few months after taking antibiotics. Call your doctor right away if you have stomach pain, cramps, or very loose, watery, or bloody stools. Check with your doctor before treating diarrhea.
What are some other side effects of this drug?
All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.
You may report side effects to your national health agency.
How is this drug best taken?
Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.
- Keep taking this drug as you have been told by your doctor or other health care provider, even if you feel well.
- Take with or without food. Take with food if it causes an upset stomach.
- Do not take antacids that have aluminum or magnesium in them within 2 hours of this drug.
- Do not take iron products within 2 hours before or 2 hours after taking this drug.
- Shake well before use.
- Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.
- You may give this drug with infant formula that has iron in it.
What do I do if I miss a dose?
- Take a missed dose as soon as you think about it.
- If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
- Do not take 2 doses at the same time or extra doses.
How do I store and/or throw out this drug?
- Store at room temperature.
- Store liquid (suspension) at room temperature. Throw away any part not used after 10 days.
- Store in a dry place. Do not store in a bathroom.
- Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
- Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
- If your symptoms or health problems do not get better or if they become worse, call your doctor.
- Do not share your drugs with others and do not take anyone else’s drugs.
- Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
- If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.
Consumer Information Use and Disclaimer
This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.
Last Reviewed Date
New Guidelines Recommend Cefdinir as First-Line Treatment for Acute Bacterial Sinusitis
ABBOTT PARK, Ill., Feb. 26 /PRNewswire-FirstCall/ — New treatment guidelines published last week by the Sinus and Allergy Health Partnership have identified Abbott Laboratories’ Omnicef(R) (cefdinir) as one of the primary treatment options for acute bacterial sinusitis. Omnicef is the only extended-spectrum cephalosporin included in the guidelines, which were developed as an educational tool for health care providers involved in managing adult and pediatric patients with acute bacterial rhinosinusitis (ABRS).
“The guidelines have been updated to provide physicians with the most current information on appropriate diagnosis and treatment, antibiotic resistance patterns and new antibiotic options for bacterial sinusitis,” said Jack Anon, M.D., FACS, Clinical Professor, University of Pittsburgh School of Medicine and one of the lead authors of the guidelines. “We included Omnicef as one of the primary treatment options for acute bacterial sinusitis because of its efficacy and tolerability in treating the infection in both adults and children.”
This is the first update for the guidelines, which were originally established in 1999 by the Sinus and Allergy Health Partnership, a not-for-profit organization created through the joint efforts of the American Academy of Otolaryngic Allergy, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Rhinologic Society.
An estimated 20 million cases of ABRS are diagnosed per year, making it the leading respiratory illness in the United States. ABRS may be diagnosed in adults or children with a viral upper respiratory infection (known as the “common cold”) that has not been resolved after 10 days or worsened after five to seven days. Symptoms may include nasal drainage or congestion, facial pressure/pain, post-nasal drainage, lessened or inability to smell, fever, cough, fatigue, maxillary dental pain and ear pressure/fullness.
Guidelines Highlight Treatment Options
The guidelines recommend Omnicef as one of the initial treatment options for adults and children with mild acute bacterial sinusitis who have not received antibiotics in the previous four to six weeks. Omnicef is also recommended as one of the initial therapies in children with mild illness who have not received antibiotics in the previous four to six weeks, and as an initial option for penicillin-allergic children who have received antibiotics in the previous four to six weeks or who have moderate symptoms. In addition to the benefit of efficacy and tolerability, the guidelines note that in the pediatric case, Omnicef is a preferred cephalosporin therapy because of high patient acceptance. Studies have shown that the taste and smell of Omnicef oral suspension is well received in children four to eight years old. According to data published in the Pediatric Infectious Disease Journal, nine out of 10 children aged four to eight preferred the strawberry taste and smell of Omnicef to other leading oral suspension antibiotics.
Contributors to the updated guidelines also addressed the important issue of antibiotic resistance. The diagnosis of bacterial “sinusitis” is often made too frequently and, as a result, patients are sometimes prescribed an antibiotic that is not only ineffective but also risks leading to increased resistance among respiratory tract pathogens. The guidelines divide patients with ABRS into two treatment categories: (1) those with mild symptoms who have not received antibiotics within the past four to six weeks, and (2) those with mild disease who have received antibiotics within the past four to six weeks or those with moderate disease regardless of recent antibiotic exposure.
“We’re pleased to see that Omnicef has been included for the first time in these important sinusitis guidelines and follows the lead of other highly respected treatment guidelines for acute bacterial sinusitis and middle ear infections,” said Mary Szela, vice president, primary care operations, Abbott Laboratories. “Omnicef is an effective and well-tolerated therapy for adults and children suffering from sinusitis. It’s also offered in a taste that children prefer, which may enhance compliance for the youngest patients.”
In 1999, the Sinus and Allergy Health Partnership originally published the treatment guidelines for ABRS to provide recommendations for diagnosing and treating ABRS; to explain the differences between viral and bacterial rhinosinusitis; to reduce the misuse of antibiotic therapy; and to describe pharmacokinetics and pharmacodynamics, and how they relate to the effectiveness of antimicrobial therapy.
Omnicef is indicated for adult, adolescent and pediatric patients (ages six months to 12 years) for the treatment of mild to moderate infections, including acute bacterial otitis media (pediatric) and acute maxillary sinusitis (adolescents and adults) due to Haemophilus influenzae (including beta-lactamase-producing strains), Streptococcus pneumoniae (penicillin- susceptible strains only) and Moraxella catarrhalis (including beta-lactamase- producing strains); and pharyngitis/tonsillitis due to Streptococcus pyogenes. Cefdinir is effective in the eradication of Streptococcus pyogenes from the orapharynx. Cefdinir has not, however, been studied for the prevention of rheumatic fever following Streptococcus pyogenes pharyngitis/tonsillitis. Only intramuscular penicillin has been demonstrated to be effective for the prevention of rheumatic fever.
Omnicef is indicated for the treatment of uncomplicated skin and skin structure infections (adults, adolescents and pediatrics) due to Streptococcus aureus (including beta-lactamase producing strains) and Streptococcus pyogenes. It is also indicated to treat acute exacerbations of chronic bronchitis and community-acquired pneumonia (adults and adolescents) due to 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).
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Omnicef and other antibacterial drugs, Omnicef should be used only to treat or prevent infections that are strongly suspected to be caused by bacteria.
Omnicef is contraindicated in patients with known allergy to the cephalosporin class of antibiotics. Patients with previous hypersensitivity to penicillins should be closely monitored when taking Omnicef. If allergic reaction to Omnicef occurs, the drug should be discontinued. The safety and efficacy of Omnicef in neonates and infants less than six months of age have not been established. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Omnicef and other antibacterial drugs, Omnicef should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
In clinical studies, Omnicef was well tolerated. In pediatric trials, the most common adverse events were: diarrhea (8 percent), rash (3 percent) and vomiting (1 percent). In adult and adolescent trials, the most common adverse effects were: diarrhea (15 percent), vaginal moniliasis (4 percent of women), nausea (3 percent), headache (2 percent), abdominal pain (1 percent) and vaginitis (1 percent of women).
For complete details, please see full prescribing information.
Source: Abbott Laboratories
10 Tips About Cefdinir for UTI
Planning to take Cefdinir for UTI? In fact, it’s one of the commonest antibiotics to treat many different infections. Moreover, back in 2008, it was the highest selling antibiotics in its class.
Cefdinir belongs to the class of “cephalosporins,” cousins to penicillins and it is a part of the beta-lactam group of antibiotics. You may have heard of another common cephalosporin: Keflex (cephalexin). Keflex is also often prescribed for UTIs but is an older drug than Cefdinir.
#1 Cefdinir or Keflex for UTI?
Cefdinir is considered the 3rd generation cephalosporin, whereas Keflex is only the first generation.
Normally, the later generations are more effective than the earlier generations, because they could fight more types of bacteria.
For example, Cefdinir treats more strains of E.coli, the most common bacteria causing UTIs, than Keflex. Cefdinir is also useful for resistant bugs that Keflex can’t kill.
#2 Do Not Use Cefdinir For An Uncomplicated UTI
Since Cefdinir is a third generation drug, only use it if anything else fails. Ask for an alternative antibiotic, if this is your first or second UTI.
Also, ask your doctor to test your bacteria and see if they are susceptible to other antibiotics before agreeing to take Cefdinir for UTI
That’s because overusing such powerful drugs sets you up for antibiotic resistance. Unfortunately, the reason scientist must engineer newer and “better” antibiotics is because the old ones are no longer effective.
Think of Penicillin, the miracle drug of the 1940s, that saved countless lives by curing infections that modern medicine previously had no way of treating. Sadly, penicillin is rarely used today because the vast majority of infection-causing bacteria are resistant to it; they have learned many tricks to block the effect of Penicillin.
#3 Plan A Hospital Stay, If Cefdinir Doesn’t Work
Because physicians prescribe antibiotics, like Cefdinir too much, we now have to deal with mutants like ESBL E.coli (extended spectrum beta-lactamase E.coli).
ESBL E.coli is a monster resistant to even our strongest antibiotics, including Cefdinir and other beta-lactam antibiotics. This is happening already- there is a growing number of reports of humans dying from so-called “superbugs” resistant to all available antibiotics.
Cefdinir is often used to treat UTI in people who have been exposed to lots of antibiotics, and therefore have more resistant strains of bacteria, that aren’t quite super-bugs.
While Cefdinir should not be prescribed for your first UTI, remember that if you’ve used antibiotics for other reasons- like chronic sinus infections- you may already have resistant bugs in your system! Also, be aware of what you eat- reports suggest that chicken may be causing your resistant UTIs.
As you can imagine, Cefdinir is not fail-proof, since more and more E. coli are becoming resistant to it.
Currently, there are five generations of cephalosporins. Drugs that belong to 4th and 5th generations are be given intravenously.
Unfortunately, if Cefdinir doesn’t work for you to cure UTI, next step is a hospital stay and invasive procedures.
#4 Cefdinir Is Not Approved By FDA For UTI
Cefdinir was first FDA approved in 1997 for infections involving the skin, throat, ears, and sinuses.
Cefdinir has been used for many years to treat urine infections as well, although technically it is not approved for this use by the FDA. Despite this, several studies show Cefdinir is able to prevent and treat UTIs – often complicated ones- with great success.
#5 Cefdinir And Your Microbiome
Cefdinir, like most other antibiotics, kills bacteria, and that means it can affect the friendly bacteria living peacefully in your digestive tract.
A study showed that a short-term use (4-14 days), does not make a big impact on gut flora. However, the researchers noticed that Cefdinir was found in stool and therefore some of the gut flora developed resistance to Cefdinir.
It’s also important to remember the study didn’t look at chronic or recurring Cefdinir use, which may have a greater impact. Also, some people may be more susceptible, such as older adults or people who already have other medical problems.
Furthermore, a common side effect of cefdinir (like nearly every other antibiotic) is diarrhea, which suggests a change in our gut flora.
It is important to have a healthy microbiome before you start antibiotics and replenish your bacterial guests once you stop the antibiotics.
#6 Keep In Mind
- Be careful if you have a history of a penicillin allergy; about 10% of people with penicillin allergies also have allergies to cephalosporin. (If you’ve taken any other cephalosporin, you should be fine.)
- If you are pregnant or breastfeeding touch base with your doctor before starting the medicine.
- Also, if you have kidney failure, you will likely need to take a smaller dose or take another antibiotic altogether.
#7 Cefdinir For UTI: Side Effects
The most common side effects of Cefdinir are:
- Vaginal yeast infections,
- Abdominal pain.
Diarrhea is the most common side effect, with about 15% of people affected, but it generally resolves after you stop the medicine. Most other side effects occur in less than 5% of people.
There are many other rare side effects- several of them serious- but tend to occur in patients with underlying diseases. If you have a serious or chronic medical problem, always let your doctor know before taking Cefdinir.
A spooky side effect that could happen on Cefdinir, especially if you take iron supplements, is red poop. However, this is not dangerous, so don’t be alarmed.
Also, of course, if you have difficulty breathing, shortness of breath, hives, swelling of the throat or other serious side effects, stop the medicine immediately and call your doctor or 911.
#8 Cefdinir Could Cause C. diff Colitis
However, let your doctor know immediately if besides diarrhea you notice other symptoms such as:
- Bloody stools,
The combination of these symptoms could be a sign of a serious problem like C. diff. C. diff colitis is a serious gut infection caused by the rise of aggressive gut destroying bugs.
#9 How To Boost Performance Of Cefdinir For UTI
Several studies show that certain compounds improve the effectiveness of antibiotics.
Why is this important?
- Antibiotics alone are not capable of fighting bacterial biofilms
- You want to get rid of as much harmful bacteria as possible to prevent future antibiotic resistance
N-acetyl cysteine (NAC)
Did you know that NAC has antioxidant and anti-inflammatory properties? And, it may also be antimicrobial and help to disrupt biofilms, the spaces bacteria like to hide out.
NAC is commonly used to improve for respiratory infections because it naturally helps clear mucus and improves symptoms. Importantly, many of the bugs that cause respiratory infections also cause UTIs.
Some studies showing NAC helps to treat UTIs as well.
A small study looking at breast cancer survivors with recurring UTIs showed that a combination of NAC, D-mannose and Morinda citrifolia. D-mannose is a UTI suppressor because it blocks E. coli from attaching to the bladder wall, while Morinda citrifolia (also known as noni) has antibacterial, anti-inflammatory and immunomodulatory effects).
Women who took this combination with antibiotics had fewer UTIs and fewer symptoms over several months. Unfortunately, these studies did not specifically look at Cefdinir, but rather other common UTI antibiotics.
Uva ursi is used in its own right to help prevent UTIs, but in combination with antibiotics, it provides an extra punch to eradicate resistance.
A component of uva ursi, corilagin, greatly reduce the amount of a beta-lactam antibiotic (remember, Cefdinir is part of this group) needed to treat an infection.
In the studies, scientists were able to decrease the amount of antibiotic needed by up to 2000 times when they added corilagin.
However, they did these tests in a laboratory, not on people. Therefore, we will have to wait for clinical studies to know for sure.
At the same time, this is really exciting news that should spur studies to find ways to combat increasing antibiotic resistance. It is important to let your doctor know if you are taking uva ursi, as you may need to adjust the dose of your antibiotics.
#10 Recover After Cefdinir: Probiotics
As mentioned above, Cefdinir- and other antibiotics– affect bad and good bacteria alike. That’s why common side-effects include yeast infection and diarrhea.
Therefore, it is important to keep healthy flora at all times, and especially when taking antibiotics.
It’s best to start off with a healthy gut before taking antibiotics and take probiotics to replenish any of your friendly gut guests that may be affected by the antibiotics you take. Remember to focus on probiotics that replenish the gut and vagina flora, such as Lactobacillus and Bifidobacterium.
Third-generation cephalosporins available in the United States are cefdinir, cefditoren, cefixime, cefotaxime, cefpodoxime, ceftazidime, ceftibuten, and ceftriaxone. The third-generation cephalosporins are major drugs for the treatment of many important infections because of their high antibacterial potency, wide spectrum of activity, low potential for toxicity, and favorable pharmacokinetics (e.g., enhanced drug concentrations in the CSF). They have been especially useful in infections resulting from gram-negative bacilli that are resistant to other β-lactam antibiotics. However, their superior activity against the Enterobacteriaceae is being challenged by the increasing frequency of organisms with β-lactamase–mediated resistance. New AmpC β-lactamases, ESBLs, and carbapenemases, which inactivate third-generation cephalosporins, present a distinct threat to the continued utility of these agents.
Cefotaxime, ceftriaxone, and ceftazidime are the major parenteral third-generation cephalosporins in clinical use for the treatment of nosocomial infections caused by susceptible gram-negative bacilli. Cefotaxime and ceftriaxone are also two of the most potent cephalosporins against penicillin-resistant pneumococci. Because of its high protein binding, ceftriaxone has the longest half-life and is usually administered once daily. Ceftazidime is dosed two or three times daily, and effective dosing of cefotaxime, which has the shortest half-life, has varied from every 4 hours to twice daily. Ceftazidime is usually reserved for infections that are likely to involve P. aeruginosa.
Monotherapy with cefotaxime or ceftriaxone has provided effective treatment for a variety of nosocomial infections caused by susceptible gram-negative bacilli, including complicated skin and soft tissue infections, prosthetic joint infections, pneumonia, complicated urinary tract infections, and intra-abdominal infections such as peritonitis.227-231 However, cephalosporin monotherapy for infections caused primarily by Enterobacter, Citrobacter, and Serratia spp. can be complicated by the emergence of stably derepressed resistant mutants.84,232 Combination antimicrobial therapy may be beneficial in reducing this emergence of resistance, which results from increased chromosomal β-lactamase production. Organisms containing ESBLs have also been observed to result in failed therapy with cephalosporins, even when the organism was judged susceptible in laboratory tests.91 The carbapenems are the recommended drugs for these ESBL-producing strains.
Cefotaxime and ceftriaxone have provided effective therapy for meningitis caused by a variety of different bacteria.233-236 They are the drugs of choice for meningitis caused by H. influenzae and various Enterobacteriaceae.237 Cefotaxime and ceftriaxone also provide effective therapy for meningitis caused by N. meningitidis and against pneumococci that have MICs of 1.0 µg/mL or less. Organisms with higher MICs have resulted in failed monotherapy with these cephalosporins. Therefore, empirical therapy with cefotaxime or ceftriaxone is combined with vancomycin (with or without rifampin) until the laboratory determines the susceptibility of the pneumococcal isolate.237 If the organism is susceptible to cefotaxime or ceftriaxone, the vancomycin (and rifampin) can be discontinued. Treatment of meningitis requires maximal doses of these cephalosporins, such as 2 g every 12 hours in adults and 50 mg/kg twice daily or 100 mg/kg once daily in children for ceftriaxone, and 2 g every 4 to 6 hours in adults or 100 to 150 mg/kg every 6 to 8 hours in children for cefotaxime.
Cefotaxime and ceftriaxone continue to be active against most bacteria producing CAP. In a large observational study of pneumococcal bacteremia, resistance to cefotaxime and ceftriaxone was not associated with higher mortality.209 Cefotaxime and ceftriaxone were also effective in treating patients with nonmeningeal pneumococcal infections, mostly pneumonia, caused by strains with MICs as high as 2 µg/mL.238 The CLSI has created higher susceptibility and resistance breakpoints for pneumococci causing nonmeningeal infections than for S. pneumoniae causing meningitis.239 As a result of these changes, cefotaxime and ceftriaxone are considered active against most penicillin-resistant pneumococci and are recommended, in combination with a macrolide, for empirical therapy for CAP requiring hospitalization.210 Single intramuscular doses of ceftriaxone are also highly effective in eradicating H. influenzae and penicillin-susceptible strains of S. pneumoniae from middle ear fluid.240 However, three daily doses of ceftriaxone were required in one study to eradicate penicillin-resistant pneumococci.241
The oral third-generation cephalosporins, which include cefdinir, cefditoren pivoxil, cefixime, cefpodoxime proxetil, and ceftibuten, are approved for oral therapy of mild-to-moderate respiratory infections, such as otitis media, sinusitis, and acute exacerbations of chronic bronchitis. These drugs have very potent activity against H. influenzae, but their activity against pneumococci is more variable.242-244 Cefdinir, cefditoren, and cefpodoxime have activity similar to that of cefuroxime or cefprozil and are active against penicillin-susceptible and most penicillin-intermediate strains of S. pneumoniae. Cefixime is active only against penicillin-susceptible strains, and ceftibuten is marginal even for penicillin-susceptible pneumococci. Short courses of most of these drugs have also provided equivalent rates of eradication in group A β-hemolytic streptococcal pharyngitis.245-247 Their increased potency over other oral cephalosporins for E. coli, K. pneumoniae, and Enterobacter, Citrobacter, and Serratia spp. enhances their utility for treatment of complicated urinary tract infections.248
Ceftazidime is the third-generation cephalosporin used for serious infections in which P. aeruginosa is documented or highly likely. It is one of the recommended drugs, either alone or in combination with an aminoglycoside, for initial empirical management of febrile neutropenia.249 However, ESBLs and AmpC β-lactamases have reduced the utility of ceftazidime for monotherapy. Continuous infusion of ceftazidime has been used to increase trough concentrations, but trials of intermittent versus continuous administration have only rarely demonstrated any significant difference in efficacy.250-252 Ceftazidime has been effective for the treatment of acute exacerbations of chronic pulmonary infections in patients with cystic fibrosis. The drug penetrates into CSF and is one of two cephalosporins as treatment of choice for meningitis caused by P. aeruginosa.253
Third-generation cephalosporins have also become established therapy for a variety of specific infections. Ceftriaxone 250 to 500 mg intramuscularly is highly active against N. gonorrhoeae, including penicillin- and quinolone-resistant strains. It is the drug of choice for all forms of gonococcal infection and is used in combination with a single oral dose of azithromycin or 7 days of oral doxycycline.224 A single oral dose of cefixime is also highly effective for uncomplicated gonococcal infections of the cervix, urethra, and rectum.254,255 However, because of increasing resistance, it is no longer recommended as first-line therapy.256 Single-dose intramuscular ceftriaxone is recommended therapy for chancroid.224 Ceftriaxone and cefotaxime are recommended therapy for treatment of early Lyme disease in patients with neurologic involvement or third-degree atrioventricular heart block.257 These drugs are also recommended in Lyme disease patients with both arthritis and objective evidence of neurologic disease and for those with late neurologic disease affecting the central or peripheral nervous system. Ceftriaxone is considered as alternative therapy in penicillin-allergic patients with syphilis.224,258 Ceftriaxone is a recommended alternative therapy for typhoid fever and for severe infections caused by Shigella spp. or by non-typhi spp. of Salmonella.259 Third-generation cephalosporins have provided effective therapy for focal Salmonella infections, brain abscess caused by gram-negative bacilli, and endocarditis caused by fastidious gram-negative coccobacilli.260,261 Single doses of ceftriaxone are highly effective in eradicating nasopharyngeal carriage of N. meningitidis.262,263 The long half-life of ceftriaxone, which allows for once-daily dosing, has enhanced its use in the outpatient setting for both streptococcal and staphylococcal infections. Ceftriaxone has been effective for the outpatient treatment of staphylococcal and streptococcal skin and soft tissue infections, including osteomyelitis and prosthetic joint infection.231,264,265 The drug is also effective as monotherapy for the outpatient treatment of nonenterococcal streptococcal endocarditis.266
Cefdinir is an antibiotic prescribed to treat a wide range of bacterial infections, including certain types of pneumonia, sinusitis, bronchitis, strep throat, sore throat, middle-ear infections, and certain skin infections.
Cefdinir belongs to a class of antibiotics called cephalosporins, which work by killing bacteria or halting their growth.
Be aware that cefdinir, which is available in capsules or in a strawberry-flavored powder that mixes with water, will not work on viral infections: It’s not a cure for the common cold or the flu.
Cefdinir was formerly sold under the brand name Omnicef, which is now discontinued.
Cefdinir should be used only to treat infections that have been proved or are strongly suspected to be bacterial, not viral. The overuse of antibiotics has been linked to the growth of antibiotic-resistant bacteria (“superbugs”).
The Food and Drug Administration (FDA) first approved cefdinir in 1997, and in 2004 approved a more concentrated liquid dosage for children six months to 12 years old, which means giving fewer teaspoons per dose.
In 2008, the FDA revised the safety label for both the capsule and liquid versions of cefdinir, warning of the risk of Clostridium difficile -associated diarrhea in patients taking cefdinir. C. difficile bacteria, which have been reported with the use of almost all antibacterial drugs, including cefdinir, can lead to fatal colitis.
Before taking cefdinir, let your doctor know of any allergies to cefdinir or penicillin, or any other cephalosporin drugs, such as cephalexin (Keflex) or cefaclor (Raniclor). Also tell your doctor if have a history of kidney disease or colitis.
Cefdinir should only be used during pregnancy if strongly needed, as there have been no well-controlled studies of the drug’s effect on pregnant women or breastfeeding women. The drug has not been detected in the breast milk of women taking it.
Since Cefdinir can affect the results of certain lab tests, such as certain diabetic-urine testing products, make sure you tell your doctor is you are taking cefdinir. The drug might also decrease the effectiveness of certain types of birth control.
Pregnancy and Cefdinir
Remicade is in the FDA’s Pregnancy Category B, meaning that there is no evidence of risk to a woman’s fetus if she takes Remicade during pregnancy.
Nonetheless, cefdinir should only be used during pregnancy if strongly needed, as there have been no well-controlled studies of the drug’s effect on pregnant women or breastfeeding women. The drug has not been detected in the breast milk of women taking it.
Antibiotics and Sinusitis
What are antibiotics?
Antibiotics are medications derived from naturally occurring chemicals produced by bacteria and molds to inhibit the growth of competing microorganisms. Penicillin was discovered in 1929 by Alexander Fleming and its popular derivative amoxicillin remains effective for 80% of acute bacterial sinus infections and 99% of strep throat infections. Although 60% of episodes of acute bacterial sinusitis will resolve without treatment, antibiotics have been consistently demonstrated to shorten the course of illness and reduce the frequency of complications from sinusitis.
When should antibiotics be used?
Antibiotics are recommended for acute bacterial sinusitis lasting longer than 10 days, or getting worse after the first week. The most common symptoms include facial pain or pressure, nasal stuffiness or congestion, and thick, discolored nasal drainage. Antibiotics are also commonly prescribed for chronic sinusitis, although many cases of chronic sinusitis are not caused by bacteria.
Why will my doctor not prescribe antibiotics over the phone?
Studies have shown that 80% of patients with acute sinusitis will improve in a week on antibiotics, while 73% of patients treated with placebo will improve. Furthermore, antibiotics will do nothing to shorten the course of the common cold. Overuse of antibiotics can breed resistant strains of bacteria and induce drug allergies in susceptible patients. Accordingly, we do not recommend antibiotics for sinus symptoms that appear to be improving spontaneously within the first 7-10 days. If you abuse antibiotics now, we may not have any options left when you really need them!
What is antibiotic resistance?
Bacterial antibiotic resistance is a significant problem in Richmond, Virginia, and throughout the United States. Many of the common bacteria that can cause sinusitis carry a gene for antibiotic resistance that can be turned on in the presence of antibiotics. After a few days of treatment, the gene becomes activated and can even travel between bacteria (in a capsule called a plasmid), creating resistance among a large population of bacteria. If you are not responding to a course of antibiotics within 4-7 days, you may have a resistant strain of bacteria. Consult your physician for an examination and possible culture or DNA analysis of your sinuses. DNA analysis of sinus drainage allows us to identify the most dangerous resistant strains within 24 hours and to provide a complete analysis of all bacteria in your nose within 1 week.
Read more about DNA analysis of chronic ENT infections
What are the most common antibiotics used for sinusitis?
Amoxicillin remains the drug of choice for acute, uncomplicated bacterial sinusitis. Amoxicillin is most effective when given frequently enough to sustain adequate levels in the infected tissue. While often prescribed twice daily, it is even more effective if taken in 3 or 4 divided doses. Amoxicillin is typically prescribed for 7-10 days at a time. While it is critical to finish the entire 10 day course of antibiotics when treating strep throat, there is evidence that shorter courses of treatment may be sufficient for most cases of sinusitis. Amoxicillin is closely related to the parent compound penicillin and should not be prescribed in patients who are penicillin allergic.
Azithromycin is an alternative treatment for patients who are allergic to amoxicillin. The principal advantage of the azithromycin is convenience — the recommended treatment for acute sinusitis is 500 mg once daily for only 3 days. Unlike amoxicillin, the effectiveness of a azithromycin is enhanced by giving a large single dose rather than spreading the doses out. For this reason, a course of azithromycin should be completed in 3 days or less for sinusitis (as in a Zithromax Tri-Pak), and should not be spread out over 5 days (as in a Zithromax Z-Pak). Azithromycin induces antibiotic resistance to itself quickly if prescribed in doses that are too low to kill the bacteria. This resistance lasts at least 3 months, so Zithromax should not be prescribed twice within 3 months . Alternatives related to azithromycin include clarithromycin (Biaxin), which is commonly taken twice daily for 10 days, and the older medications erythromycin and clindamycin which require 3-4 doses per day.
Cephalosporins and Augmentin (amoxicillin with clavulanic acid) are considered “broad-spectrum antibiotics” because they have enhanced effectiveness against a wider range of bacteria, including those that are resistant to ordinary penicillin or amoxicillin. If the patient does not improve within the first week on amoxicillin, a change to Augmentin or to a cephalosporin such as Ceftin, Cefzil, Omnicef, or Suprax is reasonable. Although these drugs have a similar mechanism of action to penicillin, they generally can be taken in adequate doses once or twice daily. These medications should be used with extreme caution in patients with a history of penicillin allergy, as cross-reaction may occur.
Cipro, Levaquin, and Avelox are generally considered third line antibiotics for uncomplicated sinusitis. These medications still have a very low rate of resistance and are often our last resort before considering surgical intervention. Allergic reactions are infrequent, but joint pain and tendon rupture have been described with patients taking these medications. They also have increased complexity interacting with other medications.
Bactrim and tetracycline are older medications which do not routinely cover the broad-spectrum of bacteria that may grow in the sinuses. However, they may have occasional use for patients with infections caused by known, resistant bacteria. In particular, these medications are prescribed for staphylococcal infections that are resistant to cephalosporins and other penicillin derivatives. This infection is known as methicillin-resistant staph aureus, or MRSA.
Topical antibiotics are a relatively new treatment option that has become popular for post surgical patients with chronic resistant bacteria. A variety of antimicrobials including vancomycin and aminoglycosides that cannot be administered by mouth are available as a nasal spray or wash. Recent studies have suggested that large volume nasal washes do a better job delivering antibiotics into the sinuses than nebulized sprays. These antibiotics can be combined with potent antifungal medications and steroids, each of which will be selected by your physician based on culture results, and custom mixed for you by a compounding pharmacist. Bactroban nasal cream (mupirocin) can be applied inside the nostrils to reduce colonization with methicillin-resistant staph aureus (MRSA).
Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, Nelson CE, Rosenfeld RM, Shaikh N, Smith MJ, Williams PV, Weinberg ST; American Academy of Pediatrics. Pediatrics. 2013 Jul;132(1):e262-80.
Current concepts in topical therapy for chronic sinonasal disease. Harvey RJ, Psaltis A, Schlosser RJ, Witterick IJ. J Otolaryngol Head Neck Surg. 2010 Jun;39(3):217-31. Review.