What is the appropriate treatment for a 5-month-old male with a recurrent upper respiratory infection (URI), presenting with a red throat, who was previously treated with sulfamethoxazole-trimethoprim (SMZ-TMP) and now has an ear infection, with a known allergy to amoxicillin (Amox)?

From the Guidelines

For a 5-month-old male with a recurrent respiratory infection and ear infection who has an amoxicillin allergy, I recommend using cefdinir suspension at 14 mg/kg/day divided into two doses for 10 days as the antibiotic treatment. This recommendation is based on the most recent and highest quality study available, which suggests that cefdinir is a suitable alternative for patients with a non-severe amoxicillin allergy 1. The study published in Pediatrics in 2013 provides evidence that cefdinir is effective against common AOM bacterial pathogens and has a low risk of cross-reactivity with penicillin allergy.

Some key points to consider in the management of this patient include:

• The use of cefdinir is supported by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) as an alternative treatment for patients with amoxicillin allergy 1.
• The dosage of cefdinir recommended is 14 mg/kg/day divided into two doses for 10 days, as outlined in the study published in Pediatrics in 2013 1.
• It is essential to note that the risk of cross-reactivity between cefdinir and penicillin is low, making it a suitable option for patients with a non-severe amoxicillin allergy 1.
• In addition to antibiotic treatment, symptom relief measures such as saline nasal drops and gentle suction with a bulb syringe before feedings and sleep, elevating the head of the crib slightly, and ensuring adequate hydration should be implemented.
• If infections continue to recur frequently, further evaluation by a pediatric ENT specialist may be warranted to rule out underlying issues like adenoid hypertrophy or immune deficiency.

From the FDA Drug Label

INDICATIONS AND USAGE Cefuroxime for Injection, USP is indicated for the treatment of patients with infections caused by susceptible strains of the designated organisms in the following diseases: Lower Respiratory Tract Infections, including pneumonia, caused by Streptococcus pneumoniae, Haemophilus influenzae (including ampicillin-resistant strains), Klebsiella spp., Staphylococcus aureus (penicillinase- and non–penicillinase-producing strains), Streptococcus pyogenes, and Escherichia coli. The patient has a URI, red throat, and was diagnosed with an ear infection. Considering the patient's allergy to amox, cefuroxime could be a potential treatment option for the patient's current infection, as it is indicated for the treatment of lower respiratory tract infections, including those caused by Streptococcus pneumoniae and Haemophilus influenzae. However, the patient's specific condition and the causative organism of the infection should be taken into consideration when selecting an antibiotic therapy 2.

• The patient's symptoms and diagnosis should be evaluated to determine the best course of treatment.
• The use of cefuroxime should be based on the results of culture and susceptibility testing, if available.
• Local epidemiology and susceptibility patterns should be considered in selecting or modifying antibacterial therapy.

From the Research

Diagnosis and Treatment of Ear Infections

• The patient's symptoms, such as ear pain and fever, are consistent with an ear infection, as described in studies 3, 4, 5.
• The diagnosis of an ear infection is typically made based on the presence of middle ear effusion and signs and symptoms of middle ear inflammation, as noted in 5.
• The patient's allergy to amoxicillin is a consideration in selecting an antibiotic, as alternative treatments such as macrolide antibiotics, clindamycin, and cephalosporins may be used, as suggested in 4, 5.

Antibiotic Treatment Options

• For patients with a penicillin allergy, such as amoxicillin, alternative antibiotics like cefdinir or azithromycin may be used, as recommended in 4.
• A study comparing the efficacy of amoxicillin/clavulanate and azithromycin in acute otitis media found that amoxicillin/clavulanate was more effective in eradicating bacterial pathogens, including Haemophilus influenzae, as reported in 6.
• Another study compared clarithromycin and amoxicillin suspensions in the treatment of acute otitis media in children and found similar clinical success rates, as noted in 7.

Management of Recurrent Infections

• The patient's history of a recent upper respiratory infection (URI) and recurrent ear infection suggests the need for close monitoring and potential consideration of preventive measures, such as pneumococcal and influenza vaccines, as mentioned in 4.
• Tympanostomy tubes may be considered in children with recurrent ear infections, as suggested in 4.