Antibiotics for Otitis Media
Antibiotic | Comments |
|---|---|
Initial treatment | |
AmoxicillinAmoxicillin | Preferred unless the child has one of the following:
High-dose regimen for possible resistant organisms |
Penicillin-allergic† | |
CefdinirCefdinir | — |
CefuroximeCefuroxime | |
CefpodoximeCefpodoxime | — |
CeftriaxoneCeftriaxone | Given IV or IM Considered particularly for children who have severe vomiting or will not swallow antibiotic liquids |
Resistant cases‡ | |
Amoxicillin/clavulanateAmoxicillin/clavulanate | Preferred; dose based on amoxicillin componentPreferred; dose based on amoxicillin component Caution required to make sure not to exceed the maximum daily dose of clavulanate |
CeftriaxoneCeftriaxone | Given IV or IM Can use even if oral cephalosporin is ineffective Considered if adherence is likely to be poor |
ClindamycinClindamycin | 2nd-line alternative, consider using with a cephalosporin |
* Treatment duration is typically 10 days for children < 2 years and 7 days for older children unless otherwise specified. Antibiotics are given orally unless otherwise specified. | |
† Cross reactivity of 2nd- and 3rd-generation cephalosporins with penicillin is very low. | |
‡ Cases are treated as resistant when patients have not improved after 48 to 72 hours of treatment, have had a previous resistant infection, have used amoxicillin in the previous 30 days, or have concurrent purulent conjunctivitis.‡ Cases are treated as resistant when patients have not improved after 48 to 72 hours of treatment, have had a previous resistant infection, have used amoxicillin in the previous 30 days, or have concurrent purulent conjunctivitis. | |
Data from Lieberthal AS, Carroll AE, Chonmaitree T, et al: The diagnosis and management of acute otitis media. Pediatrics e964–99, 2013. | |