Diagnosis and pharmacological management of acute otitis media

Pediatric Nursing, Sept-Oct, 1998 by Nancy H. Montville, Mary A. White

All of the cephalosporins are relatively expensive compared to the traditional antibiotic choices of amoxicillin, TMP/SMX, and erythromycin/ sulfisoxazole. The most costly for 10day therapy include cefprozil, cefuroxime axetil, and cefpodoxine proxetil and cefixime (Mason, 1996; Pichichero, 1994). It must be remembered that children with penicillin allergy may have a 5% to !0% crosssensitivity to cephalosporins (Eden et al., 1996). Cephalosporin antibiotics should be prescribed with caution in these children.

Newer macrolide antibiotics that may be prescribed for AOM include clarithromycin and azithromycin. Clarithromycin is infrequently used due to the poor taste of the suspension. If used, it carries the same precautions regarding possible interaction with terfenedine and cisapride as erythromycin. Azithromycin, however, does not demonstrate these drug reactions.

Azithromycin has different pharmakokinetics and is found in high concentrations at local infection site (Nahata, 1995). Studies demonstrate prolonged action in tissue sites, making it unique in long term action. A five day course of azithromycin results in therapeutic levels of the drug persisting for six days after therapy, thus allowing a once a day, fiveday antibiotic course. Azithromycin studies indicate good coverage for the three major otitis media pathogens as well as good beta-lactamase inhibition (McLinn, 1995).

In conclusion, many factors are considered when selecting a course of antibiotic therapy. See Table 1 for a summary of antibiotic therapy profiles for otitis media.