Cefdinir-induced red stools in an 8-month-old girl
Background
Cefdinir, a third-generation oral cephalosporin, is prescribed by many pediatricians for otitis media. Red-colored, non-bloody stools represent a harmless yet alarming side effect of Cefdinir when co-administered with iron-fortified formulas or iron supplements. As it is under-reported in the literature, physicians’ familiarity with it is still limited.
Case presentation
A previously healthy 8-month-old girl presented to the Emergency Department with a 5-day history of normal-consistency ‘bloody’ stools with no abdominal pain, vomiting, or fever. Examination, coagulation studies, haemoglobin and platelet levels were normal. Stools were guaiac negative (Figure 1). Intussusception was ruled out by an abdominal ultrasound. Patient was discharged on esomeprazole and instructions to come back after 24 hours for review. In her second visit, history taking revealed that she was on iron-fortified formula and was started on Cefdinir for otitis media on the same day her symptoms started. Her mother was reassured when explained that this stool discoloration was a benign side effect of Cefdinir when taken with iron-fortified formula and is reversible after cessation of the antibiotic.
Recommendations
Cefdinir or its metabolites bind with iron in the gastrointestinal tract and impart a non-absorbable complex responsible for these reddish stools.2,3 Incidence of this side effect is still unknown. The earliest case documented was in 2008 and it is still underreported (Fewer than 15 cases in the literature).1 It does not indicate discontinuation of the antibiotic as it resolves when the course is complete.1 Workup should include at most a stool guaiac test. Careful nutritional and medication history should be obtained before prescribing Cefdinir. Caregiver education about this possible side effect occurrence and its benign nature is crucial.
Conclusion
Although it is probably a relatively rare occurrence, the Cefdinir drug label should include this side effect to avoid unnecessary emergency visits and investigations.
History
Language
- English
Publisher
Hamad Medical CorporationPublication Year
- 2024
License statement
This Item is licensed under the Creative Commons Attribution 4.0 International License.Institution affiliated with
- Hamad Medical Corporation
- Sidra Medicine
- Ministry of Public Health