Red stools and Omnicef

Nelson, Jeffrey S.

doi:10.1067/mpd.2000.104524

Cited by 13 publications

(15 citation statements)

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“…In 2000, a report described two patients, a 5-month-old boy with otitis media and a 6-month-old boy with bronchopulmonary dysplasia and new-onset cough and purulent secretions, who developed red stools within 24 and 48 hours, respectively, of starting cefdinir suspension. 5 In both cases, the abnormal stools were not associated with vomiting, abdominal pain, or diarrhea. Results of stool guaiac tests, microscopic examination of the stools, and antigen studies for C. difficile were negative.…”

Section: Discussionmentioning

confidence: 79%

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Nonbloody, Red Stools from Coadministration of Cefdinir and Iron‐Supplemented Infant Formulas

Lancaster¹,

Sylvia²,

Schainker³

2008

Pharmacotherapy

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Cefdinir is an extended-spectrum, third-generation cephalosporin that may be used for treatment of acute otitis media in patients allergic to penicillin. When administered with iron-containing products, including infant formulas, cefdinir or one of its metabolites may bind to ferric ions, forming a nonabsorbable complex that imparts a reddish color to the stool. We describe a 9-month-old infant with failure to thrive and acute otitis media who developed an erythematous maculopapular rash during treatment with amoxicillin-clavulanate. His antibiotic therapy was changed to cefdinir. Five days into a 10-day course of therapy, the infant's mother brought him to the pediatric clinic and reported the appearance of red stools. He had no associated gastrointestinal symptoms (vomiting, abdominal pain, or diarrhea). His hematocrit and hemoglobin level were normal, and Clostridium difficile antigen studies and tests for species of Shigella, Salmonella, and Camphylobacter as well as ova and parasites were all negative. Cefdinir was discontinued, and his stools returned to normal within 48 hours. Three weeks later, he again received cefdinir for recurrent otitis media. Red stools reappeared 48 hours later, were determined to be guaiac negative, and resolved within hours of drug discontinuation. During both occurrences of red stools, the infant had been breastfed and was receiving supplemental feedings with an iron-containing infant formula. In the product labeling of cefdinir, this adverse event is described as a consequence of the drug-drug interaction; however, it is not listed in the adverse drug reaction section of the labeling. As such, one may miss the association between cefdinir and reddish stools when investigating this event as a potential adverse reaction to cefdinir. When using the Naranjo adverse drug reaction probability scale to assess causality in our patient's case, this adverse drug reaction was determined as highly probable. As this infant had been breastfed, the use of a supplemental iron-containing infant formula was not identified as a potential contributing factor until the second occurrence of red stools. Health care professionals should review the entire product labeling, including the drug-drug interaction section, when investigating a potential adverse drug reaction. With the recent approval of generic formulations of cefdinir, clinicians should be aware of this drug-drug interaction with iron-containing products to prevent unnecessary alarm by parents and caregivers, as well as costly medical evaluations for gastrointestinal bleeding.

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Section: Discussionmentioning

confidence: 79%

“…In the two published case reports, 5 the elemental formulas that the infants received during cefdinir therapy were Neocate One Plus (Nutricia North America, Gaithersburg, MD) and Alimentum (Ross Product Division/Abbott, Columbus, OH). Neocate One Plus contains 0.77 mg of iron/100 kcal 6 and Alimentum contains 1.8 mg/100 kcal.…”

Section: Discussionmentioning

confidence: 99%

Nonbloody, Red Stools from Coadministration of Cefdinir and Iron‐Supplemented Infant Formulas

Lancaster¹,

Sylvia²,

Schainker³

2008

Pharmacotherapy

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“…1 The amount of iron coadministered with cefdinir necessary to create red stools is unknown; however, the amount needed to form the iron cefdinir complex is probably very low based on the case reports of red stools forming while taking formula that contains iron. 3 Despite the benign nature of the cefdinir iron complex, red stools can create distress and confusion among both parents and physicians. In the above case, extra laboratory testing was obtained and the patient was admitted to the hospital overnight for a benign medication side effect.…”

Section: Discussionmentioning

confidence: 99%

“…3 This was a short case report of 2 subjects published as a letter to the editor. 3 The 2 patients reportedly developed "brick-red" stools while simultaneously taking cefdinir and iron-fortified formula.…”

Section: Literature Reviewmentioning

confidence: 99%

“…One was merely a republishing of the aforementioned case report 4 and the other an anecdotal report of red stools related to cefdinir use in the child of an academic pediatrician. 5 Finally, a search of www.google.com for "red stools" and "cefdinir" resulted in many parental reports of cefdinir causing either red-or maroon-colored stools in their children, or medication web sites reporting stool color change as a possible side effect of cefdinir.…”

Section: Literature Reviewmentioning

confidence: 99%

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Cefdinir-Associated "Bloody Stools" in an Infant

Graves

Weaver²

2008

The Journal of the American Board of Family Medicine

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Cefdinir, a third-generation oral cephalosporin frequently used in pediatric populations, may cause red stools when administered with iron or products that contain iron, such as infant formula. This benign side effect is not well documented in the medical literature. We describe a 7-month-old girl who was evaluated for red stools while taking cefdinir along with an oral iron supplement. Cefdinir is a commonly prescribed antibiotic in pediatric populations because of its once-daily dosing and its indications for acute otitis media, pharyngitis, acute sinusitis, and uncomplicated skin infections. Maroon-or red-colored stools are a known side-effect of cefdinir that have been infrequently reported in the medical literature. The manufacturer states that "there have been reports of reddish stools in patients receiving cefdinir," and adds that in many of these reports, patients were also receiving products containing iron.

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Beta-Lactam Antibiotics

Danziger

Neuhauser

2011

Drug Interactions in Infectious Diseases

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Red stools and Omnicef

Cited by 13 publications

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Nonbloody, Red Stools from Coadministration of Cefdinir and Iron‐Supplemented Infant Formulas

Nonbloody, Red Stools from Coadministration of Cefdinir and Iron‐Supplemented Infant Formulas

Cefdinir-Associated "Bloody Stools" in an Infant

Beta-Lactam Antibiotics

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