From the Guidelines
For a patient with acute otitis media who is allergic to cefdinir, I would prescribe amoxicillin-clavulanate (Augmentin) as the first-line alternative, as recommended by the American Academy of Pediatrics and the American Academy of Family Physicians 1. The recommended dosage for adults is 875 mg amoxicillin/125 mg clavulanate twice daily for 5-7 days, or 500 mg amoxicillin/125 mg clavulanate three times daily for the same duration. For children, the dosage is 90 mg/kg/day of the amoxicillin component divided into two doses for 5-7 days, as supported by studies 1. If the patient has a penicillin allergy as well, azithromycin would be an appropriate alternative, at 500 mg on day 1 followed by 250 mg daily for 4 more days for adults, or 10 mg/kg on day 1 followed by 5 mg/kg for 4 more days for children, as suggested by guidelines for community-acquired pneumonia 1. Amoxicillin-clavulanate is effective against the common pathogens in acute otitis media, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, with the clavulanate component helping overcome beta-lactamase producing strains 1. The patient should complete the full course of antibiotics even if symptoms improve before completion, and should seek follow-up care if symptoms worsen or do not improve within 48-72 hours of starting treatment, as recommended by guidelines for acute bacterial rhinosinusitis 1. Key considerations in choosing an antibiotic include the patient's allergy history, the severity of the infection, and the likelihood of resistance to certain antibiotics, as outlined in guidelines for community-acquired pneumonia and acute bacterial rhinosinusitis 1. In general, the choice of antibiotic should be based on the most recent and highest-quality evidence available, taking into account the patient's individual needs and circumstances, as emphasized by the Infectious Diseases Society of America and the American Thoracic Society 1.
From the Research
Alternative Antibiotics for Acute Otitis Media
Given the patient's allergy to cefdinir, alternative antibiotics can be considered for the treatment of acute otitis media.
- Amoxicillin/Clavulanic Acid: This combination is a recommended first-line or second-line treatment for acute otitis media, especially for patients with a history of recurrent AOM or those who have failed initial therapy 2, 3. A study comparing amoxicillin/clavulanic acid high dose with cefdinir found that the high-dose amoxicillin/clavulanic acid was significantly more effective than cefdinir in treating AOM 4.
- Azithromycin: Azithromycin is another option for the treatment of acute otitis media, particularly for patients who are allergic to penicillin or have failed first-line therapy. A study comparing 5 days of therapy with cefdinir or azithromycin in children with acute otitis media found that both antibiotics had comparable clinical cure rates 5.
- Ceftriaxone: Ceftriaxone is a third-generation cephalosporin that can be used as an alternative for patients allergic to cefdinir. It is recommended as a second-line therapy for AOM, especially for patients who have failed initial therapy or have a history of recurrent AOM 3.
- Cefpodoxime or Cefprozil: These cephalosporins are also alternatives for the treatment of acute otitis media, especially for patients who are allergic to cefdinir or have failed first-line therapy 2.
Considerations for Antibiotic Selection
When selecting an antibiotic for the treatment of acute otitis media, it is essential to consider factors such as the patient's age, weight, and medical history, as well as the severity of the infection and the likelihood of antibiotic resistance 2, 3. Additionally, the taste and dosing frequency of the antibiotic suspension can impact patient compliance 5, 2.