What is the recommended treatment for a 3-year-old with acute otitis media (AOM) treated with amoxicillin (Amoxicillin) who now presents with a rash?

From the Guidelines

For a 3-year-old who develops a rash after amoxicillin treatment for acute otitis media (AOM), the recommended approach is to discontinue amoxicillin and switch to an alternative antibiotic, such as cefdinir (14 mg/kg/day divided once or twice daily for 10 days) or cefuroxime (30 mg/kg/day divided twice daily for 10 days), as these options are less likely to cause cross-reactivity with penicillin allergy 1.

Key Considerations

• The rash is likely an allergic reaction to amoxicillin, which occurs in 5-10% of children receiving the medication 1.
• It's essential to document this reaction in the child's medical record as a potential penicillin allergy.
• Parents should be advised to monitor the rash - if it worsens, involves mucous membranes, or is accompanied by difficulty breathing, facial swelling, or other concerning symptoms, they should seek immediate medical attention.
• An antihistamine like children's diphenhydramine (Benadryl) can be given for symptomatic relief of itching at a dose of 1.25 mg/kg every 6 hours as needed.

Alternative Antibiotic Options

• Cefdinir and cefuroxime are good alternatives due to their distinct chemical structures, which reduce the risk of cross-reactivity with penicillin allergy 1.
• Azithromycin and clarithromycin may also be considered, but their use should be judicious due to potential adverse effects and resistance patterns 1.

Importance of Judicious Antibiotic Use

• Antibiotic use should be balanced against potential harms, including adverse events, resistance, and long-term health effects 1.
• Stringent diagnostic criteria and careful consideration of treatment benefits and risks are essential to minimize the impact of antibiotic overuse on resistance and individual patient outcomes.

From the FDA Drug Label

If an allergic reaction occurs, amoxicillin should be discontinued, and appropriate therapy instituted. If patients develop skin rash they should be monitored closely, and amoxicillin discontinued if lesions progress.

The recommended treatment for a 3-year-old with acute otitis media (AOM) treated with amoxicillin who now presents with a rash is to:

• Discontinue amoxicillin
• Monitor the patient closely
• Institute appropriate therapy as needed 2 2.

From the Research

Recommended Treatment for Acute Otitis Media (AOM) with Rash

• The presence of a rash in a 3-year-old with AOM treated with amoxicillin may indicate an allergic reaction, which is a common adverse effect of amoxicillin 3, 4, 5.
• According to the studies, amoxicillin is still the recommended first-line treatment for AOM, but alternative antibiotics may be considered in cases of allergy or recent use of amoxicillin 4, 6, 5.
• For patients who have failed amoxicillin treatment, second-line therapy options include high-dose amoxicillin/clavulanate, ceftriaxone, or other antibiotics that have demonstrated activity against penicillin-resistant S. pneumoniae and beta-lactamase-producing pathogens 4, 5, 7.
• The choice of antibiotic should be based on factors such as in vitro activity, pharmacokinetics, adverse events, palatability, and cost, as well as the patient's clinical presentation and medical history 4, 5.

Management of AOM with Rash

• If the rash is suspected to be an allergic reaction to amoxicillin, the antibiotic should be discontinued and an alternative treatment option should be considered 3, 4, 5.
• The patient should be closely monitored for any signs of worsening infection or adverse reactions to the new antibiotic 4, 6, 5.
• Tympanocentesis may be useful in identifying the causative pathogen and guiding further treatment, especially in cases of treatment failure or recurrent AOM 4, 5.