From the Guidelines
For patients with an amoxicillin allergy who have otitis media, cefdinir (14 mg/kg daily for 10 days) or cefuroxime (30 mg/kg per day in 2 divided doses) are recommended as alternative antibiotic options, as they are highly unlikely to be associated with cross-reactivity with penicillin allergy 1. When considering treatment for otitis media in patients with an amoxicillin allergy, it's essential to choose an antibiotic that is effective against the common bacterial pathogens, such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- The choice of antibiotic should be based on the severity of the infection, patient age, and local resistance patterns.
- Cefdinir, cefuroxime, and cefpodoxime are suitable alternatives for patients with non-severe, non-anaphylactic penicillin allergies, as they have a distinct chemical structure that minimizes the risk of cross-reactivity with penicillin 1.
- In cases of severe infection or treatment failure, other antibiotics like clindamycin (30–40 mg/kg per day in 3 divided doses) or amoxicillin-clavulanate (90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanate in 2 divided doses) may be considered, but with caution and careful evaluation of the patient's allergy history.
- Pain management with acetaminophen or ibuprofen is also crucial in treating otitis media, regardless of the chosen antibiotic.
- It's essential to monitor the patient's response to treatment and follow up with a healthcare provider if symptoms don't improve within 48-72 hours of starting treatment.
From the FDA Drug Label
For the 366 patients who were evaluated for clinical efficacy at the Day 12 visit, the clinical success rate (i.e., cure plus improvement) was 83% for azithromycin and 88% for the control agent. For the 362 patients who were evaluated at the Days 24 to 28 visit, the clinical success rate was 74% for azithromycin and 69% for the control agent. A double-blind, controlled, randomized trial was performed at nine clinical centers Pediatric patients from 6 months to 12 years of age were randomized 1:1 to treatment with either azithromycin (given at 30 mg/kg as a single dose on Day 1) or amoxicillin/clavulanate potassium (7:1), divided q12h for 10 days. For the 321 subjects who were evaluated at End of Treatment, the clinical success rate (cure plus improvement) was 87% for azithromycin, and 88% for the comparator For the 305 subjects who were evaluated at Test of Cure, the clinical success rate was 75% for both azithromycin and the comparator.
Treatment for Otitis Media with Amoxicillin Allergy: Azithromycin is a suitable alternative for the treatment of otitis media in patients with an amoxicillin allergy.
- Clinical Success Rates: The clinical success rates for azithromycin in the treatment of otitis media range from 73% to 88% in various studies 2.
- Dosage: Azithromycin can be given as a single dose of 30 mg/kg or as a 3-day course of 10 mg/kg per day.
- Efficacy: Azithromycin has been shown to be effective against common pathogens causing otitis media, including S. pneumoniae, H. influenzae, and M. catarrhalis.
From the Research
Treatment Options for Otitis Media with Amoxicillin Allergy
- For patients with an amoxicillin allergy, alternative antibiotics can be used to treat otitis media, including trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole, cefaclor, cefuroxime axetil, and cefixime 3.
- Azithromycin is another option, with a clinical success rate of 88% in treating children with otitis media, and is particularly useful for patients who require directly observed therapy or have compliance issues 4.
- Clarithromycin is also effective, with a clinical success rate comparable to amoxicillin/clavulanate, and has a lower incidence of gastrointestinal side effects 5.
- A multicentre comparative study found that azithromycin was as safe and effective as amoxicillin/clavulanic acid in treating children with otitis media, with a satisfactory response rate of 92.6% 6.
Key Considerations
- The choice of antibiotic should consider factors such as proven efficacy, cost, side effect profile, compliance issues, spectrum of coverage, and the age of the child 3.
- The emergence of bacteria resistant to amoxicillin, such as beta-lactamase-producing Haemophilus influenzae and Branhamella catarrhalis, should be taken into account when selecting an alternative antibiotic 7.