title: Cefdinir for recent-onset pediatric neuropsychiatric disorders: a pilot randomized trial.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: 1 Department of Pediatrics, University of South Florida Morsani College of Medicine , Tampa, Florida.
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
authors.forename: E Carla
authors.initials: EC
authors.lastname: Parker-Athill
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
authors.forename: P Jane
authors.initials: PJ
authors.lastname: Mutch
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000077525:Cefdinir; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000188:drug therapy*; D010865:Pilot Projects; D013981:Tic Disorders / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077525:Cefdinir