From the Guidelines
Amoxicillin is the preferred treatment for ear infections in children, as it is the first-line antibiotic treatment, typically prescribed at 80-90 mg/kg/day divided into two doses for 5-10 days, due to its effectiveness against the most common bacterial pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, as supported by the American Academy of Pediatrics guidelines 1. When considering the treatment options for ear infections in children, it's essential to weigh the benefits and risks of different antibiotics.
- Amoxicillin has been shown to be effective in treating ear infections, with approximately 83% and 87% of isolates of S pneumoniae susceptible to regular and high-dose amoxicillin, respectively 1.
- Augmentin, also known as amoxicillin-clavulanate, is an alternative option for children who are allergic to penicillin or have recurrent or complicated cases, but it is not the first-line treatment due to the potential for increased resistance and side effects 1.
- The most recent guidelines from the American Academy of Otolaryngology-Head and Neck Surgery recommend topical antibiotic therapy, such as quinolone drops, as the first-line treatment for acute tympanostomy tube otorrhea, with a success rate of 77-96% compared to 30-67% for systemic antibiotics 1. Key points to consider when treating ear infections in children include:
- Pain management using acetaminophen or ibuprofen
- "Watchful waiting" approach for mild cases in children over 2 years
- Amoxicillin as the first-line antibiotic treatment
- Alternatives for children allergic to penicillin, such as azithromycin or clarithromycin
- Topical antibiotic therapy for acute tympanostomy tube otorrhea
- Follow-up with a healthcare provider if symptoms worsen or don't improve within 48-72 hours of starting antibiotics.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Ear Infections in Children
- Amoxicillin is the first-line treatment for most cases of ambulatory ear, nose, and throat (ENT) infections that justify antibiotics 2.
- For ear infections, only purulent acute otitis media in children under 2 years of age and complicated or symptomatic forms of purulent acute otitis media (PAOM) in older children should be treated with antibiotics 2.
- High-dose amoxicillin (80-90 mg/kg/day) is recommended as the therapy of choice for uncomplicated acute otitis media in children 3.
Comparison of Amoxicillin with Alternative Agents
- Comparisons of aminopenicillin-containing regimens with alternative treatments, particularly azithromycin, have not consistently demonstrated superiority of the former 3.
- Amoxicillin-clavulanate (Augmentin) should be the treatment of choice for children between 6 months and 12 years of age with acute otitis media (AOM) 4.
- Amoxicillin-clavulanate was more effective in eradicating Streptococcus pneumoniae from the culture when compared to cefdinir 4.
Efficacy and Tolerability of Amoxicillin-Clavulanate
- Amoxicillin-clavulanate is a well-established broad-spectrum antibacterial treatment that is effective and well-tolerated in the treatment of AOM in pediatric patients 5.
- The high-dose formulation of amoxicillin-clavulanate (90/6.4 mg/kg/day) eradicated a high proportion of penicillin-resistant S. pneumoniae in a large noncomparative trial in children with AOM 5.
- Amoxicillin-clavulanate is generally well-tolerated, with a low total incidence of adverse events (3.6%) and no serious events reported from a large pediatric postmarketing study 5.
Duration of Antibiotic Treatment
- A short course of antibiotics (less than seven days) may be effective for the treatment of acute otitis media in children, with comparable outcomes to a longer course (seven days or more) of antibiotics 6.
- The absolute difference in treatment failure at 20 to 30 days suggests that at minimum 17 children would need to be treated with the long course of short-acting antibiotics to avoid one treatment failure 6.