Acute otitis media: making sense of recent guidelines on antimicrobial treatment.
High-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) remains the drug of choice for treatment of acute otitis media despite increasing antimicrobial resistance. For persistent or recurrent acute otitis media, guidelines recommend high-dose amoxicillin/clavulanate (90/6.4 mg/kg/d), cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone. Increasing the dose of amoxicillin does not cover infection with beta-lactamase-producing pathogens; add the beta-lactamase inhibitor clavulanate to amoxicillin, or choose a cephalosporin with good activity against S pneumoniae and good beta-lactamase stability. Key factors for enhancing compliance are taste of suspension, dosing frequency, and duration of therapy.
Pichichero
Michael E
ME
University of Rochester Medical Center, Elmwood Pediatric Group, 601 Elmwood Avenue, Box 672, Rochester, NY 14642, USA. michael_pichichero@urmc.rochester.edu
Casey
Janet R
JR
D000208:Acute Disease; D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015373:Bacterial Typing Techniques; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D006801:Humans; D010033:Otitis Media / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D017410:Practice Guidelines as Topic
D000900:Anti-Bacterial Agents; D000658:Amoxicillin