From the Guidelines
For patients with acute otitis media who have a penicillin allergy, the recommended treatment is cefdinir (14 mg/kg per day in 1 or 2 doses) or cefuroxime (30 mg/kg per day in 2 divided doses), as these cephalosporins have a low risk of cross-reactivity with penicillin 1. When considering treatment options for acute otitis media in patients with a penicillin allergy, it's essential to weigh the risks and benefits of different antibiotics.
- Cefdinir and cefuroxime are highly unlikely to be associated with cross-reactivity with penicillin allergy due to their distinct chemical structures 1.
- The previously cited rate of cross-sensitivity to cephalosporins among penicillin-allergic patients is likely an overestimate, and recent data suggest that the risk of cross-reactivity is lower than historically reported 1.
- For patients with non-severe penicillin allergies, cephalosporins like cefdinir or cefuroxime may be appropriate alternatives to penicillin-based treatments.
- It's crucial to determine the severity of the penicillin allergy, as patients with only mild reactions might tolerate certain beta-lactams.
- Treatment should be continued for the full course even if symptoms improve quickly to prevent recurrence.
- These alternatives are effective against common otitis media pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, though they may have slightly different coverage profiles than first-line penicillin options 1.
From the FDA Drug Label
Acute Otitis Media The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with acute otitis media is 30 mg/kg given as a single dose or 10 mg/kg once daily for 3 days or 10 mg/kg as a single dose on the first day followed by 5 mg/kg/day on Days 2 through 5.
For a patient with a penicillin allergy, azithromycin is a suitable alternative for the treatment of acute otitis media. The recommended dosage is 30 mg/kg given as a single dose or 10 mg/kg once daily for 3 days.
- The clinical success rate for azithromycin in the treatment of acute otitis media is 83-89% 2, 2, 2.
- Common side effects of azithromycin include diarrhea, vomiting, and abdominal pain.
- Azithromycin is effective against common pathogens that cause acute otitis media, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
From the Research
Treatment Options for Acute Otitis Media with Penicillin Allergy
- For patients with a penicillin allergy, alternative antibiotics such as macrolides (e.g., erythromycin, azithromycin) or cotrimoxazole can be used as first-line treatments 3, 4.
- Cefdinir or azithromycin are recommended as first-line antibiotics in patients with a penicillin allergy, due to the risk of cephalosporin allergy 5.
- A 3-day, once-daily regimen of azithromycin has been shown to have comparable clinical efficacy and tolerability to a 10-day course of cefaclor, with a lower incidence of relapse 6.
- Trimethoprim/sulfamethoxazole (TMP/SMX) is also an appropriate alternative for patients with a reported penicillin allergy 4.
Considerations for Antibiotic Treatment
- The need for antibiotics in acute otitis media is still a topic of debate, and delaying treatment by 72 hours may be a viable option for some patients 3.
- The choice of antibiotic should take into account the patient's age, severity of symptoms, and whether the acute otitis media is unilateral or bilateral 5.
- Patients with intermediately penicillin-resistant Streptococcus pneumoniae may have an impaired bacteriologic response to oral cephalosporins, such as cefaclor and cefuroxime axetil 7.