Diagnosis and pharmacological management of acute otitis media

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

Table 1. Antibiotic Therapy Profiles for Otitis Media
                                                          Beta-
DRUG                         S P      H I       M C       lactam
                                                          Inhibitor

AMOXICILLIN                  +        some      some      no
(Amoxil[R], Trimox[R])

AMOXICILLIN                  +        +         +         yes
CLAVULANATE
(Augmentin[R])

EES/Sulfasoxazole            +        +         +         yes
(Pediazole[R])

SMX/TMP                      +        +         +         some
(Bactrim[R], Septra[R])

CLARITHROMYCIN               +        some      +
(Biaxin[R])

AZITHROMYCIN                 +        +         +         yes
(Zithromax[R])

CEFACLOR (Ceclor[R])         +        some      +         yes

CEFPROZIL (Cefzil[R])        +        some      +         yes

CEFUROXIME AXETIL            +        +         +         yes
(Ceftin[R])

LORACABEF                    +        +         +         some
(Lorabid[R])

CEFIXIME (Suprax[R])         some     +         +         yes

CEFPODOXINE                  +        +         +         yes
PROXETIL (Vantin[R])

CEFTRIAXONE                  +        +         +         yes
(Rocephin[R[)

CEFTIBUTEN (Cedax[R])        +        +         +         yes

DRUG                       DOSAGE              ADVERSE
                                               REACTIONS

AMOXICILLIN                50 mg/kg/d          GI symptoms
(Amoxi[R], Trimox[R]       divided TID         Diarrhea
                           prophylaxis         Rashes - allergic
                           20 mg/kg hs

AMOXICILLIN                40 mg/kg/d          Diarrhea
CLAVULANATE                divided TID         Nausea/vomiting
(Augmentin[R])             45 mg/kg/d BID      Skin rashes

EES/Sulfasoxazole          50 mg/kg/d          GI subclinical
(Pediazole[R])             (EES)               elevation of LFTs
                           divided BID
                           to QID

SMX/TMP                    8 mg/kg TMP         Highest rate of
(Bactrim[R], Septra[R])    40 mg/kg/d          Steven-Johnson
                           SMX divided BID     Syndrome

CLARITHROMYCIN             15 mg/kg/d
(Biaxin[R])                divided
                           BID

AZITHROMYCIN               10 mg/kg/d          Gl effects
(Zithromax[R])             on day 1            Headache
                           5 mg/kg/d           Allergic
                                               reactions may
                           day 2 to 5          be prolonged

CEFACLOR (Ceclor[R])       40 mg/kg/d          GI symptoms
                           divided             Skin rashes
                           TID                 Serum sickness

CEFPROZIL (Cefzil[R])      30 mg/kg/d          Gl symptoms
                           divided             Skin rashes
                           BID                 Serum sickness

CEFUROXIME AXETIL          30 mg/kg/d          GI symptoms
(Ceftin[R])                divided             Rashes-urticaria
                           BID                 Serum sickness

LORACABEF                  30 mg/kg/d          GI symptoms
(Lorabid[R])               divided             Skin rashes-erythema
                           BID                 multiform

CEFIXIME (Suprax[R])       8 mg/kg/d           GI symptoms
                           Single dose         Skin rashes
                           Max: 400 mg         Steven Johnson
                                               Serum sickness

CEFPODOXINE                10 mg/kg/d          GI symptoms
PROXETIL (Vantin[R])       divided             Rashes
                           BID                 Increase in diarrhea

CEFTRIAXONE                50 rog/kg           GI symptoms
(Rocephin[R])              IM given            Skin rashes
                           in a single dose    Sterile abscesses
                                               Serum sickness

CEFTIBUTEN (Cedax[R])      9 mg/kg/d           GI symptoms
                           Single dose

DRUG                       COMPLIANCE          DRUG
                           ISSUES              INTERACTION

AMOXICILLIN                Needs
(Amoxi[R], Trimox[R]       refrigeration

AMOXICILLIN                Needs
CLAVULANATE                refrigeration
(Augmentin[R])             Take with food
                           6 hr between
                           doses

EES/Sulfasoxazole          QID dosing          Terfenidine
(Pediazole[R])             Poor taste          Theophylline
                                               Carbamazepine

SMX/TMP                    Poor taste          Decrease effect of
(Bactrim[R], Septra[R])    Least expensive     oral contraceptives
                                               Increase effect of
                                               oral
                                               hypoglycemics

CLARITHROMYCIN             No refrigeration    Terfenedine
(Biaxin[R])                Poor taste

AZITHROMYCIN               QD dosing for 5     May increase
(Zithromax[R])             days                theophylline levels
                           No
                           refrigeration
                           Give 1 hr ac
                           or 2 hr pc

CEFACLOR (Ceclor[R])       TID dosing
                           Needs
                           refrigeration
                           Good taste

CEFPROZIL (Cefzil[R])      Needs
                           refrigeration
                           Good taste
                           Moderate cost

CEFUROXIME AXETIL          Bitter taste
(Ceftin[R])                Better
                           absorbed with
                           food

LORACABEF                  Food
(Lorabid[R])               decreases
                           absorption -
                           Give 1 hr ac
                           or 2 hr pc

CEFIXIME (Suprax[R])       Single
                           dose q day
                           Good taste
                           No refrigeration

CEFPODOXINE                Bitter taste        Absorption
PROXETIL (Vantin[R])       Needs               decreased with
                           refrigeration       antacids and H2
                           Increased           antagonists
                           absorption
                           with food

CEFTRIAXONE                Pain at
(Rocephin[R])              injection site

CEFTIBUTEN (Cedax[R])