What are the treatment prescriptions for a patient with right otitis (inflammation of the middle ear) media and bilateral conjunctivitis (inflammation of the conjunctiva)?

From the Guidelines

For the patient with right otitis media and bilateral conjunctivitis, I recommend a dual treatment approach, prioritizing the most recent and highest quality evidence available, which suggests using amoxicillin-clavulanate for the otitis media due to the presence of conjunctivitis, and topical antibiotics for the conjunctivitis, as per the guidelines 1.

Treatment Approach

• For the otitis media, prescribe amoxicillin-clavulanate (90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanate in 2 divided doses) for 7-10 days, as recommended by the Pediatrics guidelines 1, considering the patient's concurrent conjunctivitis.
• If the patient has a penicillin allergy, alternative treatments such as cefdinir, cefuroxime, or cefpodoxime can be considered, as they are highly unlikely to be associated with cross-reactivity with penicillin allergy, according to the Pediatrics guidelines 1.

Conjunctivitis Treatment

• For the bilateral conjunctivitis, prescribe topical antibiotics such as polymyxin B-trimethoprim ophthalmic drops (1 drop in each eye every 3 hours while awake for 7-10 days) or moxifloxacin 0.5% ophthalmic solution (1 drop in each eye three times daily for 7 days), as suggested by the Ophthalmology guidelines 1 and the Clinical Microbiology and Infection recommendations 1.

Additional Recommendations

• The patient should be advised to complete the full course of antibiotics even if symptoms improve, avoid touching or rubbing the eyes, use separate towels and washcloths, and wash hands frequently.
• Warm compresses can help with eye discomfort, while over-the-counter pain relievers like acetaminophen or ibuprofen can address ear pain.

Rationale

This treatment approach targets the likely bacterial causes of both conditions, including common pathogens like Streptococcus pneumoniae and Haemophilus influenzae in otitis media, and Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae in bacterial conjunctivitis, as supported by the evidence from the Pediatrics guidelines 1 and the Ophthalmology guidelines 1.

From the FDA Drug Label

14.2 Acute Bacterial Otitis Media and Diarrhea in Pediatric Patients One U.S./Canadian clinical trial was conducted which compared 45/6. 4 mg/kg/day (divided every 12 hours) of amoxicillin and clavulanate potassium for 10 days versus 40/10 mg/kg/day (divided every 8 hours) of amoxicillin and clavulanate potassium for 10 days in the treatment of acute otitis media.

The clinical efficacy rates at the end of therapy visit (defined as 2 to 4 days after the completion of therapy) and at the follow-up visit (defined as 22 to 28 days post-completion of therapy) were comparable for the 2 treatment groups, with the following cure rates obtained for the evaluable patients: At end of therapy, 87% (n = 265) and 82% (n = 260) for 45 mg/kg/day every 12 hours and 40 mg/kg/day every 8 hours, respectively.

Prescription for Acute Bacterial Otitis Media:

• Amoxicillin-clavulanate (PO) 45/6.4 mg/kg/day divided every 12 hours for 10 days 2

In two randomized, double-masked, multicenter, controlled clinical trials in which patients were dosed 3 times a day for 4 days, moxifloxacin ophthalmic solution produced clinical cures on Day 5 to 6 in 66% to 69% of patients treated for bacterial conjunctivitis.

Prescription for Bacterial Conjunctivitis:

• Moxifloxacin (OPHTH) 0.5% ophthalmic solution, 1 drop 3 times a day for 4 days 3

From the Research

Treatment for Right Otitis Media and Bilateral Conjunctivitis

• The patient's condition involves right otitis media and bilateral conjunctivitis, which requires a comprehensive treatment approach.
• For the treatment of acute otitis media (AOM), high-dose amoxicillin (80 to 90 mg per kg per day in two divided doses) is recommended as first-line therapy, unless the patient has taken amoxicillin for AOM in the previous 30 days or has concomitant purulent conjunctivitis 4.
• In cases where the patient has concomitant purulent conjunctivitis, amoxicillin/clavulanate is typically used as an alternative 4.
• Studies have shown that amoxicillin/clavulanic acid is effective in treating AOM, with clinical response rates similar to those of oral cephalosporin comparators and significantly greater than those for intramuscular ceftriaxone in randomized trials in pediatric patients with AOM 5.
• A comparison of amoxicillin/clavulanic acid high dose with cefdinir in the treatment of AOM found that high-dose amoxicillin/clavulanic acid was significantly more effective than cefdinir as therapy for AOM, particularly in children with bona fide AOM 6.
• Another study found that amoxicillin/clavulanate was more likely to eradicate bacterial pathogens, including Haemophilus influenzae and Streptococcus pneumoniae, from middle ear fluid than azithromycin 7.

Prescriptions for Treatment

• Based on the evidence, the recommended treatment for the patient's right otitis media and bilateral conjunctivitis is:

• High-dose amoxicillin/clavulanate (80 to 90 mg per kg per day in two divided doses) for 10 days, as it is effective in treating AOM and has a broad spectrum of activity against common pathogens 5, 4, 6.
• Additional treatment for the bilateral conjunctivitis may be necessary, but the specific prescription would depend on the underlying cause and severity of the condition.

• It is essential to note that the treatment should be tailored to the individual patient's needs and medical history, and that antibiotic therapy should be used judiciously to minimize the risk of resistance and side effects 8, 5, 4.