Cefdinir for Recent-Onset Pediatric Neuropsychiatric Disorders: A Pilot Randomized Trial

Oct 10, 2014Journal of child and adolescent psychopharmacology

Cefdinir treatment for recent-onset neuropsychiatric disorders in children: a small randomized trial

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Abstract

In a small trial, 44.4% of children receiving cefdinir showed at least a 25% reduction in tic severity.

Cefdinir treatment resulted in a mean decrease of 9.5 points on the Yale Global Tic Severity Scale for those with tics.
Comparison with the placebo group revealed only 9.1% had a similar reduction in tic severity, with a mean decrease of 0.13 points.
For obsessive-compulsive disorder (OCD) symptoms, 33.3% of children on cefdinir had at least a 25% reduction in scores.
The placebo group had 27.3% showing similar improvement in OCD symptoms, with mean decreases of 7.8 and 4.7 points, respectively.
No significant differences were found between the cefdinir and placebo groups for either tic or OCD symptoms.
Cefdinir was well tolerated among participants during the study.

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OBJECTIVE: Previous studies suggest that the unexplained sudden and severe onset of obsessive-compulsive disorder (OCD) and/or tics may be infection or immune precipitated. Beta lactam antibiotics may be neuroprotective beyond their antimicrobial efficacy. We examine the preliminary safety and efficacy of cefdinir in reducing obsessive-compulsive and/or tic severity in children with new-onset symptoms.

METHOD: Twenty subjects were randomized to receive placebo or cefdinir for 30 days for the treatment of recent-onset OCD and/or tics. The placebo group received a comparable inactive treatment matched for taste, color, and consistency. The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and Yale Global Tic Severity Scale (YGTSS) were the primary outcome measures utilized.

RESULTS: Subjects receiving cefdinir saw notable improvements in tic symptoms, with 44.4% showing at least a 25% reduction in YGTSS (mean decrease=9.5) scores compared with 9.1% of the placebo group (mean decrease=0.13). Despite improvements, significant group differences were not observed for YGTSS (F [1, 13]=4.03, p=0.066) although there were moderate differences between group treatment effects (d=0.72). For OCD symptoms, subjects receiving cefdinir saw improvements in OCD symptoms, with 33.3% showing at least a 25% reduction in CY-BOCS scores (mean decrease=7.8) compared with 27.3% of the placebo group (mean decrease=4.7), but there were also no significant differences for CY-BOCS (F [1, 13]=0.385, p=0.546; d=0.24).

CONCLUSIONS: Subjects assigned to cefdinir exhibited notable, albeit nonstatistically significant, improvements in tic symptoms, compared with the placebo group. There were also some improvements in OCD symptoms, although these were not significant. Overall, cefdinir was well tolerated. Given these preliminary results, a fully powered study is warranted to explore the efficacy of cefdinir as a therapeutic tool for new-onset pediatric neuropsychiatric symptoms, particularly those that appear to be precipitated by infection.

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Cefdinir for Recent-Onset Pediatric Neuropsychiatric Disorders: A Pilot Randomized Trial

Abstract

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