Antibiotic Choices

Pediatrics for Parents, March, 2001 by Michael K. Meyerhoff

Antibiotics are great drugs and have saved millions of lives. But when overused or used improperly or inappropriately, they can lead to problems of their own. Whenever there's a new antibiotic on the market, it's frequently used by many doctors when the older, safer, and cheaper drug are just as effective.

A recent article attempted to define the role of cefdinir (Omnicef), a cephalosporin class antibiotic. It has certain advantages over other drugs in this class: superior taste and smell, once or twice a day dosing, a low rate of side effects, and proven efficacy for treating ear infections and strep throat. With such a good profile, the question is where does this new drug and any new drug fit into the treatment of these two common childhood illnesses?

Ear Infections

According to the recommendations of the Centers for Disease Control and Prevention, amoxicillin is still the preferred first choice for the treatment of otitis media (middle ear infections). It's cheap, safe, tasty, and effective. When it fails, the CDC recommends amoxicillin/clavulanate (Augmentin) in high doses, cefuroxime (Ceftin), or three shots of cefuroxime (Rocephin). Because of its good taste, the CDC recommends cefdinir as the cephalosporin of choice.

Strep Throat

A 10 day course of penicillin V is still the standard treatment choice. Recently there have been some concerns that penicillin's bacterial eradication rates are falling. Cephalosporins do have a higher eradication rate, but researchers aren't sure the higher rates make any real difference. Only five days of cefdinir is needed to treat strep throat.

So the real question is where does this drug fit into the treatment of these two common childhood infections. Few doctors would suggest it should be the first line treatment -- the older, safer, and cheaper drugs are. However, the newer drugs do have an important role when the first line drugs don't take care of the infection.

Pediatric Infectious Disease Journal, 12/00, pp. S181-3.