Is it safe to treat Acute Otitis Media (AOM) with amoxicillin in a 2-year-old female (2 YOF) with SLC39A8, a metabolic disorder, and Leigh syndrome-like symptoms?

Treatment of Acute Otitis Media in a 2-Year-Old with SLC39A8 Metabolic Disorder

Amoxicillin remains the first-line treatment for acute otitis media (AOM) in a 2-year-old female with SLC39A8 metabolic disorder and Leigh syndrome-like symptoms, but requires careful monitoring for metabolic decompensation and potential side effects. 1

First-Line Treatment Approach

• High-dose amoxicillin (90 mg/kg/day) is recommended as the first-line treatment for AOM in this child 1
• For children under 2 years, a 10-day course is recommended 1
• Pain management with acetaminophen or ibuprofen should be provided alongside antibiotic therapy 1

Special Considerations for Metabolic Disorders

When treating a child with a metabolic disorder like SLC39A8 and Leigh syndrome-like symptoms:

1. Monitor closely for signs of metabolic decompensation during infection and treatment
2. Consider potential drug interactions with any metabolic disorder medications
3. Watch for neurological symptoms that might indicate worsening of the underlying condition
4. Ensure adequate hydration during treatment to prevent metabolic stress

Alternative Options if Needed

If amoxicillin cannot be tolerated or is contraindicated:

• Amoxicillin-clavulanate (90 mg/kg/day of amoxicillin with 6.4 mg/kg/day of clavulanate) can be considered 1
• For penicillin allergy, alternatives include:
  • Clindamycin (30-40 mg/kg/day in 3 divided doses) 1
  • Ceftriaxone (50 mg/kg IM or IV daily for 3 days) if not allergic to cephalosporins 1
  • Trimethoprim/sulfamethoxazole (TMP/SMX) has been found to be an effective alternative 2

Follow-Up and Monitoring

• Assess response to treatment within 48-72 hours
• Monitor for potential side effects of antibiotics, particularly diarrhea 1
• Consider probiotic supplements to reduce gastrointestinal side effects 1
• Follow up to ensure resolution of the infection and to monitor for any complications related to the underlying metabolic disorder

Watchful Waiting Approach

While watchful waiting is sometimes recommended for AOM in children over 2 years, this approach may not be appropriate for this patient given:

1. Her young age (2 years)
2. The presence of a complex metabolic disorder
3. The risk of complications from untreated infection in a metabolically vulnerable child

Important Cautions

• Be vigilant for complications of otitis media, which may require more aggressive intervention 1
• If symptoms worsen or don't improve within 48-72 hours, reevaluate and consider changing antibiotics
• Long-term follow-up is recommended to monitor for recurrence, persistent effusion, hearing loss, and developmental assessment 1

Post-Treatment Management

• If otitis media with effusion (OME) persists after treatment, watchful waiting for 3 months is recommended 1
• Reevaluation at 3-6 month intervals is necessary until effusion resolves 1
• Age-appropriate hearing tests should be obtained if OME persists for ≥3 months 1