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Peds ID Abx QOTW #4 Answer

The appropriate first-line antimicrobial therapy is:

c) Amoxicillin low dose for 10 days

d) Amoxicillin high dose for 10 days

Here’s how others answered:


Treatment Guidelines 


Pediatrics 2013;131:e964–e999

Patient Management Recommendations

  • Options for this patient include

1) Start antimicrobial therapy

2) Observation of the patient

3) Observation with a “Wait and see” Rx (aka Safety Net Antibiotic [SNAP] or Delayed Rx)

  • What is the best option? Probably a wait and see approach would be best

“Wait and See” or Delayed Rx

  • Study in 2003 found that patients given pain management and Delayed Rx filled them only 31% of the time (Pediatrics 2003;112:527–531)

– Parents whose child had had more than 2 AOM treated with antimicrobials more likely to fill

  • For parents who are really concerned, giving them an Rx to be filled in 48hrs if not improved may provide a reassuring way to decrease antibiotic use

Antibiotic Choice in AOM

OM Abx

Why Amoxicillin over others?

  • While the most common cause is viral, the second most common is S. pneumoniae

– Rates of resistance to PCN are on the decline after PCV13 introduction

  • Drug of choice remains amoxicillin up front, for S. pneumoniae coverage

– Dosing somewhat controversial

  • High dose 80-90mg/kg is recommended
  • Data for this recommendation debatable and experts in the matter argue that low dose amoxicillin (40-45mg/kg) has similar failure rates
  • Augmentin as second-line for beta-lactamase producing Haemophilus spp. and Moraxella spp.
  • Cephalosporins maintain activity in beta-lactamase producing strains of Haemophilus and Moraxella, and have higher activity against PCN resistant S. pneumoniae