amoxicillin,first drug choice for acute otitis media

amoxicillin,first drug choice for acute otitis media

Amoxicillin is used for the treatment of acute otitis media (AOM) caused by S. pneumoniae, H. influenzae, or M. catarrhalis. Amoxicillin usually is considered the drug of first choice for initial treatment of AOM, unless the patient has severe illness (moderate to severe otalgia or fever 39C or higher) or the infection is suspected of being caused by -lactamase-producing H. influenzae or M. catarrhalis, in which case amoxicillin and clavulanate potassium is recommended for initial treatment. The American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), US Centers for Disease Control and Prevention (CDC), and others state that, despite the increasing prevalence of multidrug-resistant S. pneumoniae and presence of B-lactamase-producing H. influenzae or M catarrhalis in many communities, amoxicillin remains the anti-infective of first choice for treatment of uncomplicated AOM since it is highly effective, has a narrow spectrum of activity, is well distributed into middle ear fluid, is well tolerated, has an acceptable taste, and is inexpensive. Amoxicillin (when given in a dosage of 80-90 mg/kg daily) usually is effective in the treatment of AOM caused by S. pneumoniae, including infections involving strains with intermediate resistance to penicillins, and also usually is effective in the treatment of AOM caused by most strains of H. influenzae.

Alternatives for initial treatment of AOM in patients with a history of non-type I hypersensitivity reactions to penicillins include oral cephalosporins (cefdinir, cefpodoxime, cefuroxime axetil) or parenteral ceftriaxone. Alternatives for patients with type I penicillin hypersensitivity include oral macrolides (azithromycin, clarithromycin, fixed combination of erythromycin and sulfisoxazole), oral co-trimoxazole, or oral clindamycin (especially in those with infections known or presumed to be caused by penicillin-resistant S. pneumoniae).
AAP, AAFP, and others recommend that patients who fail to respond to an initial amoxicillin regimen (given in a dosage of 80-90 mg/kg daily) within 48-72 hours should be retreated using a regimen of amoxicillin and clavulanate potassium (90 mg/kg of amoxicillin and 6.4 mg/kg of clavulanate daily in 2 divided doses). Alternatively, a 3-day regimen of IM or IV ceftriaxone can be used for retreatment in those who fail to respond to an initial amoxicillin regimen, especially in those who have severe illness (moderate to severe otalgia or fever 39C or higher) and in those who are vomiting or cannot otherwise tolerate an oral regimen.