EARS -Otitis Media - Acute (Moraxella catarrhalis, influenzaeHaemophilus, Streptococcus pneumoniae} Note: In one third of cases no bacterial pathogen is identified. Benefits of antibiotic therapy in question. (AOM Tx Duration: If <2 years × 10 days. If ≥2 years × 5-7 days. See Pediatr Infect Dis J 1999;18:1-9.)
Amoxicillin - Drug of choice, especially if no antibiotics used in previous 30 days. If clinical failure on day 3, use alternative beta-lactam listed. (Amoxil^®, Trimox^®) Generics available Pregnancy: B; Lactation: Safe Caps: 250 mg, 500 mg Tabs: 500 mg, 875 mg Chewable Tabs: 125 mg, 250 mg Oral Susp: 50 mg/mL, 125 mg/5 mL,	Children: Dosing: 40-90 mg/kg/day (max 1500 mg/day) in divided doses three times daily. If <2 years 10 days. If ≥2 years 5-7 × days. 125 mg/5 mL at 40 mg/kg/day or 250 mg/5 mL at 80 mg/kg/day 8 kg (18 lb) = 1 tsp (5 mL) Q8H 13 kg (29 lb) = 1½ tsp (7.5 mL) Q8H 17 kg (37 lb) = 2 tsp (10 mL) Q8H 21 kg (46 lb) = 2½ tsp (12.5 mL) (NTE 500 mg) Q8H 25 kg (55 lb) = 3 tsp (15 mL) (NTE 500 mg) Q8H Adult: 875 mg twice daily or 500 mg three times daily for 5-10 days.		Food: May take with or without meals. Important side effects: Diarrhea and nausea. May cause nonallergic maculopapular rash. Reduce dose in renal disease (CrCl <30 mL/min).
Amoxicillin/clavulanate (Augmentin^®) Pregnancy: B; Lactation: Unk Q12H Formulations (7:1): Tabs: 875 mg/125 mg Chewable Tabs: 200 mg/28.5 mg, 400 mg/57 mg Oral Susp: 200 mg/28.5 mg/5 mL, 400 mg/57 mg/5 mL Augmentin ES-600 Powder for Oral Suspension (14:1): 600 mg/42.9 mg/ 5 mL .	Children: 80-90 mg amoxicillin component/kg/day (max 1600 mg/day) in divided doses two times daily. If <2 years × 10 days. If ≥2 years × 5-7 days. 14:1 (ES-600) formulation is advised, especially if antibiotic exposure for otitis media in preceding 3 months and either age ≤2 years or daycare attendance. If low likelihood of resistant S. pneumoniae, may use 7:1 formulation; however, limit clavulanate to no more than 10 mg/kg/day (amoxicillin 70 mg/kg/day). Q12H using 600/5 mL susp @ 90 mg/kg/day 8 kg (18 lb) = 3 mL Q12H 12 kg (26 lb) = 4.5 mL Q12H 16 kg (35 lb) = 6 mL Q12H 20 kg (44 lb) = 7.5 mL Q12H 24 kg (53 lb) = 9.0 mL Q12H 28 kg (62 lb) = 10.5 mL Q12H 32 kg (70 lb) = 12.0 mL Q12H 36 kg (79 lb) = 13.5 mL Q12H >40 kg = Experience not available. If low likelihood of resistant S. pneumoniae, may use 7:1 formulation; however, limit clavulanate to no more than 10 mg/kg/day (amoxicillin 70 mg/kg/day). Q12H using 400 mg/57 mg/5 mL suspension @ 70 mg/kg/day: 11 kg (24 lb) = 1 tsp (5 mL) Q12H 17 kg (37 lb) = 1½ (7.5 mL) tsp Q12H 23 kg (51 lb) = 2 tsp (10 mL) Q12H >23 kg = Use adult dose. Adult: 500-875 mg twice daily for 10 days.		Food: Take with food to reduce diarrhea. Important side effects: Diarrhea (common), nausea, rash. May cause nonallergic maculopapular rash. Use with caution in hepatic disease. Reduce dose if renal impairment (CrCl <30 mL/min).
Cefpodoxime (Vantin^®) Pregnancy: B; Lactation: Unsafe Tabs: 100 mg, 200 mg Oral Susp: 50 mg/5 mL, 100 mg/5 mL	Children >2 months to 12 years: 10 mg/kg/day (NTE 400 mg) in divided doses once or twice daily. If <2 years × 10 days. If ≥2 years × 5-7 days. 100 mg/5 mL @ 10 mg/kg/day 10 kg (22 lb) = 1 tsp (5 mL) Q24H 20 kg (44 lb) = 2 tsp (10 mL) Q24H 30 kg (66 lb) = 3 tsp Q24H Adult: 100-200 mg PO twice daily for 5-7 days.		Food: Take tablets with food. Suspension may be taken without regard to food. Important side effects: Diarrhea.
Cefuroxime axetil (Ceftin^®) Pregnancy: B; Lactation: Unsafe Tabs: 125 mg, 250 mg, 500 mg Oral Susp: 125 mg/5 mL, 250 mg/5 mL	Children >3 months to 12 years: 30 mg/kg/day (NTE 1,000 mg/day) in divided doses twice daily. If <2 years × 10 days. If ≥ 2 years × 5-7 days. 125 mg/5 mL @ 30 mg/kg/day 8 kg (18 lb) = 1 tsp (5 mL) Q12H 12.5 kg (27 lb) = 1½ tsp (7.5 mL) Q12H 17 kg (37 lb) = 2 tsp (10 mL) Q12H 25 kg (55 lb) = 1 tbsp Q12H 33 kg (73 lb) = Use adult dose. Adult: 250-500 mg PO twice daily for 5-7 days.		Food: Take suspension with food. Tablets may be taken without regard to food. Important side effects: Nausea, vomiting, diarrhea.
Trimethoprim/Sulfamethoxazole* Alternative for beta-lactam intolerance. (Bactrim^®, Septra^®)	Children >2 months: 8-10 mg/kg/day TMP component (max 320 mg/day) in divided doses twice daily for 5-10 days.		Food: May take without regard to food. Encourage fluids.
Generics available Pregnancy: C; Lactation: Unsafe Single Strength (SS) Tabs: 80 mg/400 mg Double Strength (DS) Tabs: 160 mg/800 mg Oral Susp: 40 mg/200 mg per 5 mL May be less active against penicillin resistant S. pneumoniae.	8-10 mg/kg/day @ 40 mg/200 mg/5 mL 10 kg (22 lb) = 1 tsp (5 mL) Q12H 20 kg (44 lb) = 2 tsp (10 mL) or 1 SS tab Q12H 30 kg (66 lb) = 3 tsp (15 mL) or 1½ SS tab Q12H 40 kg (88 lb) = 4 tsp (20 mL) or 2 SS tabs or 1 DS tab Q12H Adult: 1 DS tab PO twice daily for 5-10 days.		Important side effects: Photosensitivity, rash.
EARS - Otitis Media - Failed Treatment
Levofloxacin* (Levaquin^®) Pregnancy: C; Lactation: Unsafe Tabs: 250 mg, 500 mg - >$$$$	Adult: 500 mg PO once daily for 10-14 days.	Food: With or without meals. Do not take within 2 hours of antacids, magnesium, calcium supplements, zinc, aluminum, sucralfate, vitamins, or minerals (iron or zinc). Important side effects: Photosensitivity, dizziness. Reduce dose if renal impairment (CrCl <50 mL/min).
Ceftriaxone (Rocephin^®) Pregnancy: B; Lactation: Unk Vials: 250 mg, 500 mg, 1,000 mg 1 g - $$$	Children and Adult: 50 mg/kg (max 1 g) IM daily × 1-3 days.