Pediatric Acute Otitis Media Organism-Specific Therapy
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Organism-specific therapeutic regimens for pediatric acute otitis media are provided below, including those for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and viral or sterile effusion. [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]
Intermediate resistance or penicillin-susceptible:
Amoxicillin 80-90 mg/kg/day (maximum 3 g/24h) PO divided BID for 5-10d or
Ceftriaxone 50 mg/kg (maximum 1 g) IM × 1 dose
Highly resistant and severe disease with complications:
Vancomycin 40 mg/kg/day (maximum 4 g/24h) IV divided q6-8h for 10d
See the list below:
Amoxicillin-clavulanate 80-90 mg/kg/day (maximum 4 g/24h) PO divided BID for 5-10d or
Ceftriaxone 50 mg/kg (maximum 1 g) IM × 1 dose or
Cefdinir 14 mg/kg/day (maximum 600 mg/24h) PO daily or divided BID for 5-10d or
Cefpodoxime 10 mg/kg/day (maximum 400 mg/24h) PO daily or divided BID for 5-10d or
Cefuroxime 30 mg/kg/day (maximum 1 g/24h) PO divided BID for 5-10d
See the list below:
Amoxicillin-clavulanate 80-90 mg/kg/day (maximum 4 g/24h) PO divided BID for 5-10d or
Ceftriaxone 50 mg/kg (maximum 1 g) IM × 1 dose or
Cefdinir 14 mg/kg/day (maximum 600 mg/24h) PO daily or divided BID for 5-10d or
Cefpodoxime 10 mg/kg/day (maximum 400 mg/24h) PO daily or divided BID for 5-10d or
Cefuroxime 30 mg/kg/day (maximum 1 g/24h) PO divided BID for 5-10d
See the list below:
None
[Guideline] American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004 May. 113(5):1451-65. [Medline]. [Full Text].
Brook I, Gober AE. Microscopic characteristics of persistent otitis media. Arch Otolaryngol Head Neck Surg. 1998. 124:1350-2.
Johns Hopkins Hospital, Custer JW, Rau RE. The Harriet Lane Handbook: A Manual for Pediatric House Officers. 18th ed. Mosby; 2009.
Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA. 2010 Nov 17. 304(19):2161-9. [Medline].
Dohar J, Giles W, Roland P, et al. Topical ciprofloxacin/dexamethasone superior to oral amoxicillin/clavulanic acid in acute otitis media with otorrhea through tympanostomy tubes. Pediatrics. 2006 Sep. 118(3):e561-9. [Medline]. [Full Text].
Steele RW, Blumer JL, Kalish GH. Patient, physician, and nurse satisfaction with antibiotics. Clin Pediatr (Phila). 2002 Jun. 41(5):285-99. [Medline].
Natal BN, Chao JH. Otitis Media in Emergency Medicine. Medscape Reference. Updated Feb 26, 2010. Available at http://emedicine.medscape.com/article/764006-overview.
Gerber JS, Prasad PA, Russell Localio A, et al. Variation in Antibiotic Prescribing Across a Pediatric Primary Care Network. J Pediatric Infect Dis Soc. 2015 Dec. 4 (4):297-304. [Medline].
Saleh EA, Schroeder DR, Hanson AC, Banerjee R. Guideline-concordant antibiotic prescribing for pediatric outpatients with otitis media, community-acquired pneumonia, and skin and soft tissue infections in a large multispecialty healthcare system. Clin Res Infect Dis. 2015 Jan 10. 2 (1):[Medline]. [Full Text].
Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar. 131 (3):e964-99. [Medline]. [Full Text].
Brenda L Natal, MD, MPH Assistant Professor of Emergency Medicine, Simulation Director, Rutgers New Jersey Medical School; Attending Physician, Department of Emergency Medicine, University Hospital of Newark
Brenda L Natal, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American Medical Association
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.
Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic
Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio
Disclosure: Nothing to disclose.
Pediatric Acute Otitis Media Organism-Specific Therapy
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