1. + = Red Stools and Omnicef (cefdinir):
What Family Doctors Should Know (a case report)
Reese Graves, MD and Sally P. Weaver, PhD, MD
McLennan County Medical Education and Research Foundation, Family Medicine Residency Program, Waco, Texas
CASE REPORT
PREVIOUS CASE REPORTS
DISCUSSION
Two similar reports in the medical literature:
- A 6 year old and a 5 month old (both receiving iron-containing formula) developed red stools within 24 hours of their 1st dose of cefdinir.2
- A child of a pediatric faculty member developed red stools while taking cefdinir.3
G.R. is a 7-month-old Hispanic female who presented to the ER with maroon-colored stools six days after starting cefdinir (Omnicef®) for otitis media.
PMHx:
apnea of prematurity
dietary anemia
occult blood positive stools as an outpatient <2wks prior to ER visit.
after evaluation, anal fissures were thought to be the cause.
Omnicef (cefdinir)1
- extended spectrum, 3rd generation cephalosporin antibiotic
- indicated for treatment of pneumonia, acute otitis media, pharyngitis, acute sinusitis, and uncomplicated skin infections.
CONCLUSIONS
Red stools can occur in patients taking cefdinir and iron supplements/formula.
A hemoccult stool test differentiates this from true melena.
Family doctors need to be aware of this side effect to caution parents and prevent unnecessary workups. + =
Red Stools
LABS: Hgb/Hct: 11.9/34.3, Platelets: 429, Comp metabolic panel: wnl, PT/PTT: wnl, Hemoccult: negx2
VITALS: AF, BP 97/60,
HR 130, 99% O2
EXAM: playful, non-toxic, normal exam except for two small anal fissures, brisk capillary refill.
RED STOOLS are thought to be due to a reaction between iron and cefdinir (or its breakdown products) in the gastrointestinal tract creating a nonabsorbable red compound that discolors the stools.
HOSPITAL COURSE: admitted for observation. --After an uneventful course and discovery of cefdinir/iron interaction, G.R. was discharged. --No further stool discoloration was reported by parents after she completed her course of cefdinir.
REFERENCES:
Omnicef (cefdinir) package insert. Parke-Davis. North Chicago, IL: Abbott Laboratories; 2005.
Nelson, JS. Red stools and Omnicef. Letter to the Editor. Journal of Pediatrics. 2000;136(6):
Nelson, JD, McCracken, GH. Red stools and Omnicef. The Pediatric Infectious Disease Journal Newsletter. 2002;21(4):A7-A8.