Skip to Main Content
TABLE 5

Recommended Antibiotics for (Initial or Delayed) Treatment and for Patients Who Have Failed Initial Antibiotic Treatment

Initial Immediate or Delayed Antibiotic TreatmentAntibiotic Treatment After 48–72 h of Failure of Initial Antibiotic Treatment
Recommended First-line TreatmentAlternative Treatment (if Penicillin Allergy)Recommended First-line TreatmentAlternative 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 TreatmentAntibiotic Treatment After 48–72 h of Failure of Initial Antibiotic Treatment
Recommended First-line TreatmentAlternative Treatment (if Penicillin Allergy)Recommended First-line TreatmentAlternative 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.

a

May be considered in patients who have received amoxicillin in the previous 30 d or who have the otitis-conjunctivitis syndrome.

b

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.

c

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.

Close Modal

or Create an Account

Close Modal
Close Modal