Pediatric emergency medicine trisk 1130 1130

TABLE 58.1
ANTIBIOTIC TREATMENT OF AOM
First line
Amoxicillin 80–90 mg/kg/day in two doses
Amoxicillin-clavulanate 90 mg/kg/day amox in two doses
Penicillin allergy
Cefdinir 14 mg/kg/day in one or two doses
Cefpodoxime 10 mg/kg/day in two doses
Cefuroxime 30 mg/kg/day in two doses
Ceftriaxone 50 mg IM or IV for 3 days
Treatment failure (after 48–72 hrs)
Amoxicillin-clavulanate 90 mg/kg/day amox in two doses
Ceftriaxone 50 mg IM or IV for 3 days
Alternative
Clindamycin 30–40 mg/kg/day in three doses plus third-generation
cephalosporin
Tympanocentesis and culture
High-dose amoxicillin (80 to 90 mg/kg/day in two divided doses) is the initial
drug of choice for AOM provided the patient is not penicillin-allergic, has not
taken amoxicillin during the preceding 30 days, does not have concurrent
purulent conjunctivitis (H. influenza more likely), and does not have a history of
AOM treatment failure with amoxicillin ( Table 58.1 ). Amoxicillin-clavulanate
(80 to 90 mg/kg/day of amoxicillin, with 6.4 mg/kg/day of clavulanate in two
divided doses) is recommended for antibiotic treatment failure, defined as
worsening or persistent symptoms after 48 to 72 hours. Alternatives for treatment
failure are ceftriaxone (50 mg IM or IV for 1 or 3 days) or clindamycin (30 to 40
mg/kg/day in three divided doses) plus a third-generation cephalosporin.
Tympanocentesis and culture may be indicated after multiple antibiotic failures in
persistently symptomatic patients.
Patients with a history of penicillin allergy may be treated with cefdinir (14
mg/kg/day in one or two divided doses), cefpodoxime (10 mg/kg/day in two

divided doses), cefuroxime (30 mg/kg/day in two divided doses), or ceftriaxone
(50 mg IM or IV for 1 or 3 days). These specific cephalosporins do not share
similar side-chain structure with penicillin, ampicillin, or amoxicillin, and
therefore pose little risk of allergic reaction in penicillin-allergic patients.