From the Guidelines
For a 1.5-year-old with otitis media not responding to cefdinir after 3 days, the next appropriate step would be to switch to amoxicillin-clavulanate (Augmentin) at a dose of 90 mg/kg/day of the amoxicillin component, divided twice daily for 10 days. This recommendation is based on the guidelines for the diagnosis and management of acute otitis media, which suggest that amoxicillin-clavulanate is an appropriate choice for children who have not responded to initial antibiotic treatment 1. The use of amoxicillin-clavulanate addresses the possibility of beta-lactamase producing organisms or resistant Streptococcus pneumoniae that may not respond to cefdinir.
Some key points to consider in the management of this patient include:
- The importance of monitoring for clinical improvement within 48-72 hours after changing antibiotics 1
- The need for immediate evaluation by a healthcare provider if the child has severe symptoms or appears toxic, to consider tympanocentesis for culture and possible parenteral antibiotics
- The continuation of pain management with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours) as needed
- The recommendation for follow-up within 48-72 hours after changing antibiotics to ensure clinical improvement
It's also important to note that while 3 days may seem insufficient for complete resolution, lack of any improvement by this time warrants a change in management, as suggested by the guidelines for the diagnosis and management of acute otitis media 1.
From the FDA Drug Label
CLINICAL STUDIES Clinical Trials in Pediatric Patients With Acute Bacterial Otitis Media In two adequate and well controlled US clinical trials a single IM dose of ceftriaxone was compared with a 10 day course of oral antibiotic in pediatric patients between the ages of 3 months and 6 years The next step for a 1.5-year-old with otitis media not responding to cefdinir after 3 days could be a single IM dose of ceftriaxone, as it has been studied in pediatric patients between the ages of 3 months and 6 years for acute bacterial otitis media 2.
- Key points:
- Ceftriaxone has been compared with a 10-day course of oral antibiotic in clinical trials.
- The clinical cure rates and statistical outcome appear in the table in the drug label.
- Ceftriaxone may be considered as an alternative treatment option for otitis media in pediatric patients who do not respond to initial treatment with cefdinir.
From the Research
Next Steps for Treatment
If a 1.5-year-old with otitis media is not responding to cefdinir after 3 days, the following options can be considered:
- Switching to a different antibiotic, such as amoxicillin/clavulanic acid, which has been shown to be effective in treating acute otitis media (AOM) in children 3, 4, 5, 6
- Considering a longer course of antibiotic treatment, as some studies suggest that a 10-day course may be more effective than a 5-day course 3, 4
Alternative Antibiotic Options
Some alternative antibiotic options that can be considered include:
- Amoxicillin/clavulanic acid, which has been shown to be effective in treating AOM in children, especially in cases where cefdinir is not effective 3, 4, 5, 6
- Ceftriaxone, which has been shown to be effective in treating AOM in children, especially in cases where other antibiotics are not effective 4
Considerations for Treatment
When considering alternative treatment options, the following factors should be taken into account:
- The severity of the infection and the patient's overall health
- The potential for antibiotic resistance and the need to choose an antibiotic that is likely to be effective against the causative pathogen
- The potential for adverse effects and the need to choose an antibiotic that is well-tolerated by the patient 5, 6, 7