Recommended Antibiotics for (Initial or Delayed) Treatment and for Patients Who Have Failed Initial Antibiotic Treatment
| Initial Immediate or Delayed Antibiotic Treatment . | Antibiotic Treatment After 48–72 h of Failure of Initial Antibiotic Treatment . | ||
|---|---|---|---|
| Recommended First-line Treatment . | Alternative Treatment (if Penicillin Allergy) . | Recommended First-line Treatment . | Alternative Treatment . |
| Amoxicillin (80–90 mg/ kg per day in 2 divided doses) | Cefdinir (14 mg/kg per day in 1 or 2 doses) | Amoxicillin-clavulanatea (90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanate in 2 divided doses) | Ceftriaxone, 3 d Clindamycin (30–40 mg/kg per day in 3 divided doses), with or without third-generation cephalosporin |
| or | Cefuroxime (30 mg/kg per day in 2 divided doses) | or | Failure of second antibiotic |
| Amoxicillin-clavulanatea (90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanate [amoxicillin to clavulanate ratio, 14:1] in 2 divided doses) | Cefpodoxime (10 mg/kg per day in 2 divided doses) | Ceftriaxone (50 mg IM or IV for 3 d) | Clindamycin (30–40 mg/kg per day in 3 divided doses) plus third-generation cephalosporin |
| Tympanocentesisb | |||
| Ceftriaxone (50 mg IM or IV per day for 1 or 3 d) | Consult specialistb | ||
| Initial Immediate or Delayed Antibiotic Treatment . | Antibiotic Treatment After 48–72 h of Failure of Initial Antibiotic Treatment . | ||
|---|---|---|---|
| Recommended First-line Treatment . | Alternative Treatment (if Penicillin Allergy) . | Recommended First-line Treatment . | Alternative Treatment . |
| Amoxicillin (80–90 mg/ kg per day in 2 divided doses) | Cefdinir (14 mg/kg per day in 1 or 2 doses) | Amoxicillin-clavulanatea (90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanate in 2 divided doses) | Ceftriaxone, 3 d Clindamycin (30–40 mg/kg per day in 3 divided doses), with or without third-generation cephalosporin |
| or | Cefuroxime (30 mg/kg per day in 2 divided doses) | or | Failure of second antibiotic |
| Amoxicillin-clavulanatea (90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanate [amoxicillin to clavulanate ratio, 14:1] in 2 divided doses) | Cefpodoxime (10 mg/kg per day in 2 divided doses) | Ceftriaxone (50 mg IM or IV for 3 d) | Clindamycin (30–40 mg/kg per day in 3 divided doses) plus third-generation cephalosporin |
| Tympanocentesisb | |||
| Ceftriaxone (50 mg IM or IV per day for 1 or 3 d) | Consult specialistb | ||
IM, intramuscular; IV, intravenous.
May be considered in patients who have received amoxicillin in the previous 30 d or who have the otitis-conjunctivitis syndrome.
Perform tympanocentesis/drainage if skilled in the procedure, or seek a consultation from an otolaryngologist for tympanocentesis/drainage. If the tympanocentesis reveals multidrug-resistant bacteria, seek an infectious disease specialist consultation.
Cefdinir, cefuroxime, cefpodoxime, and ceftriaxone are highly unlikely to be associated with cross-reactivity with penicillin allergy on the basis of their distinct chemical structures. See text for more information.