What is the recommended treatment for bacterial otitis media in an 11-year-old child weighing 103 pounds?

Treatment of Bacterial Otitis Media in an 11-Year-Old Child

For an 11-year-old child weighing 103 pounds (approximately 47 kg) with bacterial otitis media, high-dose amoxicillin (80-90 mg/kg/day) is the recommended first-line treatment. 1

Diagnostic Considerations

• Accurate diagnosis is crucial before initiating treatment
• Key diagnostic findings include:
  • Bulging of the tympanic membrane
  • Limited or absent mobility of the tympanic membrane
  • Air-fluid level behind the tympanic membrane
  • Distinct erythema of the tympanic membrane
  • Otorrhea (if present)

Treatment Algorithm

First-Line Therapy

• High-dose amoxicillin: 80-90 mg/kg/day divided into two doses for 5 days
  • For a 47 kg child: approximately 3,800-4,200 mg daily (1,900-2,100 mg twice daily)
  • Effective against approximately 87% of Streptococcus pneumoniae strains
  • Favorable safety profile, low cost, and acceptable taste 1

Second-Line Therapy (if first-line fails or special circumstances)

• Amoxicillin-clavulanate: Indicated when beta-lactamase-producing strains of H. influenzae or M. catarrhalis are suspected 1
• Alternative options for penicillin allergy (non-type I):
  • Cefuroxime-axetil
  • Cefpodoxime-proxetil 2, 1
• For type I penicillin allergy:
  • Macrolides (azithromycin, clarithromycin) 1
  • For azithromycin: 10 mg/kg (approximately 470 mg) on day 1, followed by 5 mg/kg (approximately 235 mg) on days 2-5 3

Duration of Treatment

• For an 11-year-old child: 5 days of therapy is appropriate 2, 1
• Treatment duration for children under 2 years is longer (7-10 days) 1

Pain Management

• Immediate pain control with:
  • Acetaminophen or ibuprofen at age-appropriate doses
  • Topical analgesics as complementary treatment 1

Follow-up and Treatment Failure

• Assess response to therapy within 48-72 hours 1
• Treatment failure is defined as:
  • Worsening of the patient's condition
  • Persistence of symptoms for more than 48 hours after starting antibiotics
  • Recurrence of symptoms within 4 days of completing treatment 2

Special Considerations

• If otitis is associated with purulent conjunctivitis, H. influenzae is likely; consider amoxicillin-clavulanate or cefuroxime-axetil 2
• If febrile painful otitis is present, S. pneumoniae is likely but H. influenzae should also be considered 2
• Persistent middle ear effusion for up to 2 weeks after treatment is common and represents otitis media with effusion (OME), not treatment failure 1

Prevention

• Ensure pneumococcal and influenza vaccinations are up-to-date 1
• Reduce risk factors:
  • Limit exposure to tobacco smoke
  • Consider daycare attendance patterns 1

By following this treatment approach, bacterial otitis media in this 11-year-old child can be effectively managed while minimizing complications and promoting optimal clinical outcomes.