We present a case of 50-year-old male patient with a known history of cirrhosis of liver, hepatic encephalopathy, hepatitis C, stimulant use disorder, methamphetamine type and major depressive disorder, with psychotic features who presented to the emergency department for altered mental status.Patient was previously admitted 5 days ago for acute encephalopathy to medicine service and after stabilization, transferred to a psychiatry inpatient service for worsening depression. He was started on Lexapro 5 mg and Zyprexa 5 mg for major depressive disorder with psychotic features and at the time of presentation he had already been taking these medications for the past 10 days.When the patient was seen at the ER, he was lying in
Background: Cefdinir, an extended spectrum third generation cephalosporin is very commonly used in paediatric population. The American Academy of Paediatrics (AAP) recommends it as an alternative agent for initial treatment of acute otitis media in penicillin allergic patients. One of its harmless side effects is reddish coloured heme negative stools due to interaction with iron and iron containing products. This side effect is reversible upon drug discontinuation. However, dearth of literature and case reports on this common side effect has led to inattention to this issue and is not communicated to parents and caregivers. When encountered with bloody stool during the course of treatment with cefdinir, high concern from parents lead to unnecessary emergency room visit. This adds burden to already overworked health system escalating the practice of cost un-effective medicine.
Case Presentation:We present an 8-month old infant girl currently treated with Cefdinir and being formula fed, who presented to the Emergency Department and was further evaluated for red stools. On systemic examination, gastrointestinal findings were normal and hemoccult test of the stool returned negative for heme.
Conclusion:Cefdinir is commonly prescribed for infants who are also commonly on iron fortified diet. Paediatricians should expect the occurrence of red coloured stool once therapy with cefdinir is started and inform about the potential side effect that is not dangerous. This timely communication can save from unnecessary emergency room visits. Reporting this case adds to the scanty literature information we have on one of the common, and harmless side effects of cefdinir.
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