AOM - failure of first line agents
- persistent (still symptomatic at 48 - 72 h)
S. pneumoniae
Moraxella catarrhalis
H. influenzae
Occasionally:
Group A Streptococci
S. aureus
Second line agents:
Failure of standard dose amoxicillin
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin | 45mg/kg/d PO div bid-tid | 10 days |
| + | ||
|
Amoxicillin-clavulanate (7:1 - Clavulin -200 or -400) |
45mg/kg/d PO div bid-tid | 10 days |
Failure of high dose amoxicillin
| Empiric Therapy | Duration | |
|---|---|---|
|
Amoxicillin-clavulanate (7:1 - Clavulin -200 or -400) |
45mg/kg/d PO div bid | 10 days |
Penicillin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| [Clindamycin | 20-40mg/kg/d PO div tid | 10 days |
| + | ||
| Cefixime] | 8mg/kg/d PO div bid | |
| or | ||
| Ceftriaxone | 50mg/kg IM/IV daily | 3 days |
Severe penicillin allergy or cephalosporin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Levofloxacin | 10-20mg/kg/d PO div q12-24h | 10 days |