Template:Otitis Media Antibiotics

Initial Treatment

High Dose Amoxicillin

• <2 months
  • Amoxicillin 30mg/kg/day PO divided q12h x 10 days
  • First Dose: 15mg/kg PO x 1
• 2 months - 5 years
  • Amoxicillin 80-90mg/kg/day PO divided q12h x 10 days
  • First Dose: 40-45mg/kg PO x 1
  • Max: 1000mg/dose
• 6-12 years
  • Amoxicillin 80-90mg/kg/day PO divided q12h x 5-10 days
  • First Dose: 40-45mg/kg/day PO x 1
  • Max: 1000mg/dose

Treatment during prior Month

1. If amoxicillin taken in past 30 days, Amoxicillin/Clavulanate
   • 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
   • Clavulanate increases vomiting/diarrhea
2. Cefdinir 14mg/kg/day BID x7-10 days
3. Cefpodoxime 10mg/kg PO daily x7-10 days
4. Cefuroxime 15mg/kg PO BID x7-10 days
5. Cefprozil 15mg/kg PO BID x7-10 days

Otitis/Conjunctivitis

• Suggestive of non-typeable H.flu

1. Amoxicillin/Clavulanate
   • 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
   • Clavulanate increases vomiting/diarrhea

Treatment Failure

defined as treatment during the prior 7-10 days

1. Amoxicillin/Clavulanate 80-90mg of amoxicillin per kg/day PO divided BID x 7-10 days
2. Ceftriaxone 50mg/kg IM once as single injection x 3 days
   • Use if cannot tolerate PO

Penicillin Allergy

1. Azithromycin 10mg/kg/day x 1 day and 5mg/kg/day x 4 remaining days
2. Clarithromycin 7.5mg/kg PO BID x 10 days
3. Clindamycin 10mg/kg PO three times daily
   • Clindamycin does not cover H. influenza and M. catarrhalis and treatment should favor Azithromycin use

• Cephalexin 75-100mg/kg/day PO divided q12h x 10 days; Max: 4,000mg/24h