From the Guidelines
For acute otitis media (AOM) with concern for pneumonia coverage, amoxicillin is the preferred first-line antibiotic, with a recommended dosage of 80 to 90 mg per kg per day. This recommendation is based on the guideline released by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) 1. The choice of amoxicillin as first-line therapy is due to its effectiveness against susceptible and intermediate resistant pneumococci, as well as its safety, affordability, and acceptable taste. When considering pneumonia coverage, it is essential to note that amoxicillin's narrow microbiologic spectrum is still effective against common AOM pathogens, including Streptococcus pneumoniae, which is also a common cause of pneumonia. Some key points to consider when prescribing amoxicillin for AOM with potential pneumonia coverage include:
- The dosage should be 80 to 90 mg per kg per day, as specified in the AAP and AAFP guideline 1
- Amoxicillin is generally effective against susceptible and intermediate resistant pneumococci
- Alternative antibiotics, such as cefdinir, cefpodoxime, or cefuroxime, can be prescribed for patients allergic to amoxicillin, provided the allergic reaction is not a type I hypersensitivity reaction 1.
From the FDA Drug Label
Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae. Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy.
Azithromycin covers Streptococcus pneumoniae, which is a common cause of both Acute Otitis Media (AOM) and pneumonia 2.
- Key points:
- Azithromycin is effective against Streptococcus pneumoniae.
- It can be used to treat AOM and community-acquired pneumonia caused by this bacterium.
From the Research
Antibiotic Coverage for AOM and Pneumonia
- The antibiotics used to treat Acute Otitis Media (AOM) also provide coverage for pneumonia, particularly those caused by Streptococcus pneumoniae and Haemophilus influenzae 3, 4, 5, 6, 7.
- Amoxicillin/clavulanate is a commonly used antibiotic for AOM, which has been shown to be effective against S. pneumoniae and H. influenzae, including penicillin-resistant and beta-lactamase-producing strains 3, 4, 7.
- High-dose amoxicillin/clavulanate (90/6.4 mg/kg/day) has been found to be more effective than azithromycin in eradicating S. pneumoniae and H. influenzae in children with AOM 3.
- The use of amoxicillin/clavulanate as a first-line treatment for AOM is recommended, with alternative agents such as ceftriaxone and cefuroxime axetil considered for patients who fail initial treatment 5, 6.
Bacterial Etiology of AOM
- The most common bacterial pathogens causing AOM are S. pneumoniae, H. influenzae, and Moraxella catarrhalis 3, 4, 5, 6, 7.
- The resistance patterns of these pathogens vary by region, and local surveillance data are essential for guiding antibiotic therapy 5, 6.
Clinical Efficacy of Antibiotics
- Amoxicillin/clavulanate has been found to be clinically effective in treating AOM, with success rates ranging from 80% to 95% 3, 4, 7.
- Azithromycin has also been used to treat AOM, but its efficacy is lower than that of amoxicillin/clavulanate, particularly against S. pneumoniae and H. influenzae 3, 7.