What is the recommended antibiotic treatment for a 9-year-old outpatient with recurrent otitis media?

From the Guidelines

For a 9-year-old outpatient with recurrent otitis media, the recommended antibiotic treatment is high-dose amoxicillin (80 to 90 mg per kg per day) 1. This option is based on extrapolation from microbiologic studies and expert opinion, with preponderance of benefit over risk. The choice of a first-line treatment should be based on the anticipated clinical response and the microbiologic flora likely to be present.

Key Considerations

• Amoxicillin is recommended as first-line therapy for AOM because it is generally effective when used in sufficient doses against susceptible and intermediate resistant pneumococci.
• If the patient is allergic to amoxicillin and the allergic reaction is not a type I hypersensitivity reaction, the physician can prescribe cefdinir, cefpodoxime, or cefuroxime.
• The optimal duration of therapy for patients with AOM is uncertain, but a 7- to 10-day course of oral antibiotic is commonly used 1.
• Recent guidelines suggest that watchful waiting may be a valid approach for children with recurrent AOM and no middle ear effusion (MEE) at the time of assessment, as the natural history of the condition is often favorable and the benefits of tympanostomy tubes are uncertain 1.

Additional Recommendations

• Pain management with acetaminophen or ibuprofen should be provided as needed.
• If the child experiences multiple recurrences (3 episodes in 6 months or 4 in 12 months), referral to an otolaryngologist for consideration of tympanostomy tubes may be warranted.
• It's essential to complete the full course of antibiotics even if symptoms improve before completion.

From the FDA Drug Label

One US/Canadian clinical trial was conducted which compared 45/6. 4 mg/kg/day (divided every 12 hours) of amoxicillin and clavulanate potassium for 10 days versus 40/10 mg/kg/day (divided every 8 hours) of amoxicillin and clavulanate potassium for 10 days in the treatment of acute otitis media. The clinical efficacy rates at the end of therapy visit (defined as 2-4 days after the completion of therapy) and at the follow-up visit (defined as 22-28 days post-completion of therapy) were comparable for the 2 treatment groups, with the following cure rates obtained for the evaluable patients: At end of therapy, 87% (n = 265) and 82% (n = 260) for 45 mg/kg/day every 12 hours and 40 mg/kg/day every 8 hours, respectively. At follow-up, 67% (n = 249) and 69% (n = 243) for 45 mg/kg/day every 12 hours and 40 mg/kg/day every 8 hours, respectively.

The recommended antibiotic treatment for a 9-year-old outpatient with recurrent otitis media is amoxicillin-clavulanate. The dosage is 45/6.4 mg/kg/day divided every 12 hours for 10 days 2.

From the Research

Recommended Antibiotic Treatment

For a 9-year-old outpatient with recurrent otitis media, the recommended antibiotic treatment is not explicitly stated in the provided studies for a patient of this specific age. However, we can look at the available evidence for guidance:

• A study from 2003 3 found gatifloxacin to be efficacious and safe for the treatment of recurrent/nonresponsive acute otitis media in patients aged 6 to 48 months.
• Another study from 1992 4 reported the efficacy and safety of oral ciprofloxacin in children with chronic suppurative otitis media without cholesteatoma, although the age range of the patients was not specified, it did include 21 children.

Key Points to Consider

• The choice of antibiotic should be based on the susceptibility of the causative pathogens, which can vary depending on the region and the patient's previous antibiotic use.
• Resistance to antibiotics is a growing concern, as shown in a study from 2004 5, which found an increase in ciprofloxacin-resistant Pseudomonas aeruginosa in patients with chronic suppurative otitis media.
• The use of topical antibiotics, such as ciprofloxacin, has been shown to be effective in treating chronic otitis media, as reported in a study from 1990 6.

Available Treatment Options

• Gatifloxacin: shown to be effective in treating recurrent/nonresponsive acute otitis media in younger patients 3.
• Ciprofloxacin: effective in treating chronic suppurative otitis media, both orally 7, 4 and topically 6, but resistance is a concern 5.
• Amoxycillin/clavulanic acid: less effective than ciprofloxacin in treating chronic suppurative otitis media, as reported in a study from 1994 7.