Treatment Of Otitis Media In Children

A 6-year-old girl presents with her first episode of otitis media. She has been treated with antibiotics on one prior occasion for a urinary tract infection. She has no known drug allergies. Which of the following is the most appropriate antibiotic to treat this patient?

A. Cefuroxime
B. Azithromycin
C. Amoxicillin
D. Cephalexin
E. Amoxicillin/clavulanic acid

 Answer : C.Amoxicillin

Discussion:  Otitis media is a common pediatric diagnosis requiring antibiotic therapy. Many antibiotics are effective in providing coverage for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, the major pathogens associated with acute otitis media. 

Antibiotics that are active against these pathogens include 

• amoxicillin, 
• sulfonamides, 
• second-generation cephalosporins, and 
• macrolides. 

Cephalexin, a first-generation cephalosporin, does not provide adequate coverage for these pathogens. In addition to effectiveness, appropriate antibiotic selection should consider the cost of the medication and promotion of bacterial resistance. Increasing use of more expensive broad-spectrum antibiotics has led to increasing bacterial resistance to antibiotics. Thus, amoxicillin remains the first-line antibiotic choice for otitis media and other classes of antibiotics should be reserved for those with suspected bacterial resistance (i.e., persistent or recurrent infections) and those with allergies to penicillins. 

Risk factors for patients being infected with penicillin-resistant bacteria include day care attendance, recurrent otitis media, and multiple recent courses of antibiotics.