SandboxAlonso

Empiric treatment of AOM.

Initial treatment Preferred Regimen (susceptible to penicillin) ▸ Amoxicillin 40-45 mg/kg PO q12h OR ▸ Amoxicillin-clavulanate 90/6.5 mg/kg/day PO divided in 2 doses Alternative Regimen (penicillin allergy or resistant strains) ▸ Cefdinir 14 mg/kg PO q24h OR ▸ Ceftriaxone 50 mg/kg IM or IV q24h OR ▸ Cefuroxime 15 mg/kg PO q12h OR ▸ Cefpodoxime 5 mg/kg PO q12h

Initial treatment Preferred Regimen (susceptible to penicillin) ▸ Amoxicillin-clavulanate 90/6.5 mg/kg/day PO divided in 2 doses OR ▸ Ceftriaxone 50 mg/kg IM or IV q24h Alternative Regimen (penicillin allergy or resistant strains) ▸ Clindamycin 10 mg/kg PO q8h PLUS ▸ Ceftriaxone 50 mg/kg IM or IV q24h

• Failure of initial antibiotic treatment is defined as lack of clinical improvement during the first 48 to 72 hours. Fever should decrease and irritability should disappear of considerably decline.
• If severe symptoms remain or worsen antibiotic treatment should be changed. Recommended changes appear below:

• Children receiving amoxicillin should receive high dose amoxicillin-clavulanate
• Children receiving amoxicillin-clavulanate or oral third-generation cephalosporines should receive IM or IV ceftriaxone
• Three day treatment with ceftriaxone is recommended

• Tympanocentesis should be considered if more than one regimen has failed
• Clindamycin should be administered to patients who didn't respond to several antibiotic treatments and tympanocentesis can't be performed.