Question: ENT / ID
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During the recent “tri-demic” of influenza, RSV, and COVID disease, there was also a nationwide shortage of common oral liquid antibiotics used to treat otitis media. Which of the following antibiotics is recommended in the 2013 AAP guidelines as an alternative to amoxicillin to treat acute otitis media?
Kelly February 8, 2023 - 12:02 am
High dose amoxicillin 80-90 mg/kg/day in 2 divided doses is the recommended first-line treatment for acute otitis media in the 2013 AAP guidelines. Children who have taken amoxicillin in the last 30 days or who have concurrent purulent conjunctivitis should receive amoxicillin-clavulanate for better coverage of beta-lactamase positive H. influenzae and M. catarrhalis. Alternative antibiotics include cefdinir, cefuroxime, cefpodoxime, and IM ceftriaxone. These cephalosporin alternatives are also recommended for patients with a penicillin allergy (unless the allergic reaction was severe / life-threatening) as cross-reactivity between penicillin and 2nd and 3rd generation cephalosporins is negligible. Macrolides have limited efficacy against H. influenzae and S. pneumoniae. Trimethoprim-sulfamethoxazole and Erythromycin-sulfisoxazole were used in the past, but S. pneumoniae resistance is now too high for these agents. Cephalexin (1st generation cephalosporin) is not recommended due to high resistance of organisms that commonly cause otitis media.