Cefdinir for recent-onset pediatric neuropsychiatric disorders

Knowledge Bank

Methods:

A total number of 20 subjects were randomized to receive cefdinir or placebo for 30 days for the treatment of recent-onset OCD and/or tics. The placebo group received a similar inactive treatment matched for taste, color, and consistency. The primary outcome measures of the study were Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and Yale Global Tic Severity Scale (YGTSS).

"The patients treated with cefdinir demonstrated remarkable, albeit non-statistically significant, improvements in tic symptoms, compared to the placebo group"

Results:

The study revealed the following results:

Patients receiving cefdinir showed remarkable improvements in tic symptoms, with 44.4% showing at least a 25% reduction in YGTSS scores compared to 9.1% of the placebo group
Patients receiving cefdinir showed improvements in OCD symptoms, with 33.3% showing at least a 25% reduction in CY-BOCS scores compared to 27.3% of the placebo group; however there were also no significant differences for CY-BOCS.

Conclusion:

The investigators therefore concluded that the patients treated with cefdinir demonstrated remarkable, albeit non-statistically significant, improvements in tic symptoms, compared to the placebo group. There were also some improvements in OCD symptoms, even though these were not significant. In general it was concluded that cefdinir was well tolerated. Further clinical research is necessary to explore the efficacy of cefdinir as a therapeutic tool for new-onset pediatric neuropsychiatric symptoms, mainly those that appear to be precipitated by infection.

Source: Murphy TK, Parker-Athill EC, Lewin AB, Storch EA, Mutch PJ. Cefdinir for recent-onset pediatric neuropsychiatric disorders: a pilot randomized trial. J Child Adolesc Psychopharmacol. 2015 Feb;25(1):57-64.

Case report

Propitious role of cefdinir in acute bacterial pharyngitis with co-associated otitis media

Case presentation

A 12-year-old girl accompanied by her mother presented to a pediatrician with chief complaints of fever, pain in the ear and sore throat since 6 days. The patient was seen by a family physician 2 days after she developed fever and throat pain and was started empirically on amoxicillin. Despite of being given antibiotic therapy, she reported increasing throat pain, dysphagia and fever. She also developed vague pain in the left year leading to difficulty in sleeping. Family history of the patient was non-contributory.

Examination

General examination
The patient was febrile with a body temperature of 100.60F; blood pressure was 110/60 mmHg; heart rate was 82 beats per minute; and respiratory rate was normal.

Oral examination:
Her tonsils were symmetrically enlarged with membranous exudate adhering to the posterior wall of pharynx and the uvula was not deviated.

Abdominal examination:
The abdomen was non-tender and no hepatic or splenic enlargement was present.
The patient was advised to get an otoscopy, antistreptolysin-O (ASLO) titres and routine throat swab cultures done.

Diagnosis and evaluation

Otoscopy revealed an inflamed and bulging eardrum
Throat swab culture test: Positive for streptococci
Antistreptolysin-O (ASLO) titres: (1:80) normal

Based on the above-mentioned clinical and diagnostic findings, a diagnosis of acute bacterial pharyngitis with coassociated otitis media was made.

Management

The patient was started on cefdinir 300 mg twice daily for 10 days along with an antihistamine and nasal drops for 5 days. The patient showed significant improvement in throat and ear pain on fifth day of therapy. The inflammation of the ear drum had significantly reduced. Throat examination showed the absence of adherent exudate and tonsil size was close to normal.

Discussion

Cefdinir is a broad spectrum third generation oral cephalosporin with an extended coverage against Gram-positive, Gram-negative and anaerobic bacteria. It efficiently combats the most common respiratory tract pathogens including Haemophilus influenzae, Moraxella catarrhalis and penicillin-susceptible Streptococcus pneumoniae. Cefdinir is resistant to hydrolysis by plasmid-mediated beta-lactamases and demonstrates excellent activity against beta-lactamase producing strains of H. influenzae and M. catarrhalis. Its effectiveness in bacterial infections such as otitis media and acute pharyngitis is well-documented in medical literature. The drug easily disseminates into various tissues (sinus and tonsil) and fluids (middle ear) and is almost completely eliminated via kidneys in unchanged form. Plenty of data accrued from clinical reports supports the utility of the drug in pediatric infections. The present case of a child with acute bacterial pharyngitis with concomitant otitis media was effectively managed with cefdinir treatment for 10 days. The patient showed a marked improvement in pain and dysphagia on the fifth day of the therapy. Examination revealed a substantial improvement in throat as well as ear drum inflammation. Her fever subsided and sleep patterns became normal.

Cefdinir for recent-onset pediatric neuropsychiatric disorders

Safedinir (Cefdinir)

Cefdinir for recent-onset pediatric neuropsychiatric disorders: A pilot randomized trial