What is the recommended dose and medication for a 13-year-old female with acute otitis media (AOM) of the left ear?

Medication and Dosage for Acute Otitis Media in a 13-Year-Old Female

High-dose amoxicillin (80-90 mg/kg/day divided in two doses for 10 days) is the recommended first-line treatment for this 13-year-old female with acute otitis media of the left ear. 1

Diagnosis Confirmation

Before prescribing antibiotics, ensure proper diagnosis by:

• Confirming moderate to severe bulging of the tympanic membrane or new onset otorrhea
• Isolated redness of the tympanic membrane with normal landmarks is not AOM and does not require antibiotics 2
• Adequate visualization of the tympanic membrane is essential 1

First-Line Treatment

For a 13-year-old with confirmed AOM:

• High-dose amoxicillin: 80-90 mg/kg/day divided in two doses for 10 days 1
• This dosage provides optimal coverage against Streptococcus pneumoniae, the most common bacterial pathogen in AOM 3
• Higher dosing (75-90 mg/kg/day) is recommended to overcome resistant strains of S. pneumoniae 3

Alternative Treatments

If the patient received amoxicillin in the last 30 days or has treatment failure:

• Switch to amoxicillin-clavulanate: 90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day of clavulanate in 2 divided doses 1
• This provides coverage against beta-lactamase-producing organisms like H. influenzae and M. catarrhalis 4

For penicillin allergy:

• Non-type I allergy: Cefdinir (14 mg/kg/day in 1-2 doses), cefuroxime (30 mg/kg/day in 2 doses), or cefpodoxime (10 mg/kg/day in 2 doses) 1
• Type I allergy: Consider azithromycin at age-appropriate dosing 5

Pain Management

Pain relief is essential regardless of antibiotic use:

• Acetaminophen or ibuprofen for systemic pain relief 1
• Topical analgesics may provide faster relief (within 10-30 minutes) 2

Treatment Duration and Follow-up

For a 13-year-old with AOM:

• 10-day treatment course is recommended 1
• Reassess within 48-72 hours if symptoms worsen or fail to improve 1

Treatment Failure Considerations

Treatment failure is defined as:

• Worsening of symptoms
• Persistence of symptoms for more than 48 hours after starting antibiotics
• Recurrence within 4 days after completing treatment 1

If treatment fails:

• Switch to high-dose amoxicillin-clavulanate if initially treated with amoxicillin 1
• Consider tympanocentesis with bacterial culture for recurrent or persistent cases 1

Common Pitfalls to Avoid

1. Underdosing amoxicillin: Standard doses (40 mg/kg/day) are inadequate for resistant S. pneumoniae 3
2. Overlooking pain management: Pain control is essential regardless of antibiotic therapy 1
3. Treating without proper visualization: Antibiotics should not be prescribed without adequate examination of the tympanic membrane 2
4. Treating isolated redness: Isolated redness of the tympanic membrane with normal landmarks is not AOM and does not require antibiotics 2
5. Failing to reassess: Follow-up is important if symptoms persist or worsen 1

Prevention of Recurrence

• Consider pneumococcal and influenza vaccines 1
• Reduce risk factors such as tobacco smoke exposure 1
• Consider antibiotic prophylaxis for truly recurrent cases 1