Antibiotics for Otitis Media
Antibiotic | Comments |
|---|---|
Initial treatment | |
Amoxicillin | Preferred unless the child has one of the following:
High-dose regimen for possible resistant organisms |
Penicillin-allergic† | |
Cefdinir | — |
Cefuroxime | |
Cefpodoxime | — |
Ceftriaxone | Given IV or IM Considered particularly for children who have severe vomiting or will not swallow antibiotic liquids |
Resistant cases‡ | |
Amoxicillin/clavulanate | Preferred; dose based on amoxicillin component Caution required to make sure not to exceed the maximum daily dose of clavulanate |
Ceftriaxone | Given IV or IM Can use even if oral cephalosporin is ineffective Considered if adherence is likely to be poor |
Clindamycin | 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. | |
Data from Lieberthal AS, Carroll AE, Chonmaitree T, et al: The diagnosis and management of acute otitis media. Pediatrics e964–99, 2013. | |