From the FDA Drug Label
Skipping doses or not completing the full course of therapy may: (1) decrease the effectiveness of the immediate treatment, and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by amoxicillin and clavulanate potassium tablets or other antibacterial drugs in the future The child may require further antibiotic treatment, as the full course of antibiotics was not completed, which can lead to decreased effectiveness of treatment and increased risk of bacterial resistance. However, the decision to prescribe antibiotics again should be based on a thorough evaluation of the child's condition, including the results of a throat swab, and consultation with a healthcare professional. Key considerations include:
- The child's symptoms, such as persistent fevers
- The results of the throat swab
- The risk of bacterial resistance
- The potential benefits and risks of further antibiotic treatment 1
From the Research
Yes, this 5-year-old child should receive further antibiotic treatment. Since the child did not complete the full course of amoxicillin for what was likely streptococcal pharyngitis and/or otitis media, and is still experiencing persistent fevers, a new complete course of antibiotics is necessary. The recommended treatment would be high-dose amoxicillin (80-90 mg/kg/day divided twice daily) for 10 full days, as suggested by the most recent and highest quality study available 2. If there's concern about amoxicillin resistance or penicillin allergy, alternatives include amoxicillin-clavulanate or, for penicillin-allergic patients, cefdinir, cefuroxime, or azithromycin. It's crucial that the entire antibiotic course be completed this time, even if symptoms improve before the medication is finished. Incomplete antibiotic courses can lead to partially treated infections, bacterial resistance, and recurrent or worsening infections. The persistent fever suggests that the original infection was not fully eradicated, and without complete treatment, complications such as rheumatic fever or kidney inflammation could develop, particularly if Group A Streptococcus is involved.
Some key points to consider:
- The child's incomplete antibiotic course may have led to partial treatment of the infection, increasing the risk of complications and antibiotic resistance 3.
- The most recent and highest quality study available suggests that penicillin can still be regarded as a first choice treatment for both adults and children with streptococcal pharyngitis 2.
- Alternative antibiotics, such as azithromycin, may be effective in treating streptococcal pharyngitis, but may have a higher risk of adverse events in children 4.
- Delayed antibiotic prescription in acute otitis media and guidelines for fever and respiratory infections can effectively reduce antibiotic prescription in the ED 5.
However, in this case, given the child's persistent fever and incomplete antibiotic course, further antibiotic treatment is necessary to prevent potential complications and ensure complete eradication of the infection. The child should receive a new complete course of antibiotics, and the entire course should be completed to minimize the risk of complications and antibiotic resistance.