What antibiotic can be prescribed to cover ear infections, upper respiratory infections (URIs), or pneumonia?

Antibiotic Selection for Ear Infections, Upper Respiratory Infections, and Pneumonia

Amoxicillin is the first-line antibiotic for ear infections, upper respiratory infections, and pneumonia, with amoxicillin-clavulanate as the preferred alternative when beta-lactamase-producing pathogens are suspected. 1

First-Line Treatment Options

Acute Otitis Media (Ear Infection)

• For children under 2 years: Antibiotic therapy is recommended (Grade A) 1
• For children over 2 years: Antibiotics may be withheld unless marked symptoms (high fever, intense earache) are present (Grade B) 1
• First-line treatment: Amoxicillin at high dose (80-90 mg/kg/day) to overcome resistant pneumococci 1
• Duration: 5-8 days (Professional consensus) 1

Upper Respiratory Tract Infections

• Most URIs are viral and don't require antibiotics 1
• For bacterial sinusitis:
  • First-line: Amoxicillin (high-dose) 1
  • Alternative: Amoxicillin-clavulanate, especially with severe symptoms or recent antibiotic exposure 1

Pneumonia

• For children <3 years: Amoxicillin 80-100 mg/kg/day in three daily doses (Grade B) 1
• For children >3 years:
  • If pneumococcal infection suspected: Amoxicillin
  • If atypical bacteria (Mycoplasma, Chlamydia) suspected: Macrolides 1
• For adults: Amoxicillin 3g/day for pneumococcal pneumonia 1
• Duration: 10 days for pneumococcal pneumonia, 14 days for atypical pneumonia 1

Second-Line Treatment Options

When to Use Amoxicillin-Clavulanate

• When beta-lactamase-producing H. influenzae or M. catarrhalis are suspected 1, 2
• In children <5 years with insufficient H. influenzae vaccination or coexisting purulent otitis media 1
• For treatment failures after amoxicillin 3
• Dosage: 80 mg/kg/day of amoxicillin component 1

When to Use Cephalosporins

• Cefuroxime-axetil or cefpodoxime-proxetil as alternatives when amoxicillin fails 1
• Avoid cefixime for respiratory infections due to inadequate activity against resistant pneumococci 1

When to Use Macrolides

• For patients with beta-lactam allergies 1
• For suspected atypical pathogens (Mycoplasma, Chlamydia) 1
• Not recommended as first-line for most respiratory infections due to pneumococcal resistance 1

Special Considerations

Treatment Failure Assessment

• Evaluate efficacy after 2-3 days of treatment 1
• If amoxicillin fails after 48 hours, consider atypical bacteria and switch to macrolide 1
• For persistent symptoms despite appropriate therapy, consider hospitalization 1

Antibiotic Selection Algorithm

1. First-line: High-dose amoxicillin (80-90 mg/kg/day)
2. Second-line (if first-line fails or specific risk factors):
   • Amoxicillin-clavulanate
   • Cefuroxime-axetil or cefpodoxime-proxetil
3. Third-line: Ceftriaxone or combination therapy 4

Cautions

• Avoid fluoroquinolones in children 1
• Azithromycin is not a first-line antibiotic for any pediatric URI and is often used inappropriately 1
• Macrolide resistance in pneumococci is increasing, limiting their effectiveness 1

Monitoring and Follow-up

• Reassess after 48-72 hours if symptoms persist 1
• For pneumonia, fever should resolve within 24-48 hours for pneumococcal infection, but may take 2-4 days for other etiologies 1
• Consider radiological reassessment if no improvement is observed 1

Remember that antibiotic selection should target the most likely pathogens (S. pneumoniae, H. influenzae, and M. catarrhalis) while considering local resistance patterns and patient-specific factors such as age, severity of illness, and previous antibiotic exposure 1.