Clinical pearl: Cefdinir and “bloody” stools: no need for your …: News in emergency medicine
Cefdinir is a third generation cephalosporin commonly prescribed in pediatrics to treat otitis media, urinary tract infections, pharyngitis and skin infections. (Pediatrician Emerg Care. 2021; 37: e421; J Infect Chemother. 2020; 26: 286; Rev pediatrician. 2009; 30: 146.)
All published pediatric cases have occurred when oral cefdinir has been administered concomitantly with an iron-containing product, such as an iron fortified infant formula or an oral iron supplement formulation. (Pediatrician Emerg Care. 2021; 37: e421.)
The pathogenesis of this phenomenon occurs in the gastrointestinal tract when cefdinir or its metabolites combine with iron to form an unabsorbable precipitant, which imparts a reddish color to the stool. It is a benign entity; cefdinir was arrested without consequences.
A thorough drug and dietary history should be taken to confirm simultaneous oral ingestion of iron when a patient receiving oral cefdinir presents to the emergency department with red stools. Such a presentation likely represents a self-limiting drug interaction if a stool test for occult blood is negative, without the need for further assessment and management.
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