Medication Summary
Antibiotics are the only medications with demonstrated efficacy in the management of AOM. Most antibiotics can be administered once or twice daily to improve compliance and to avoid the necessity of sending medication to school or day care centers. The following list excludes medications that have reduced activity against common pathogens or that have significant adverse effects without other redeeming features to warrant inclusion.
Antibiotics
Class Summary
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Amoxicillin (Amoxil, Trimox, Wymox)
DOC for management of AOM. Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.
Amoxicillin/clavulanate (Augmentin)
Combination drug that includes a blocking agent (clavulanic acid).
Erythromycin base / sulfisoxazole (E.E.S. 400)
Doses supplied in 200 mg/5 mL (erythromycin) and 600 mg/5 mL (sulfisoxazole). Widely used for individuals who are penicillin-sensitive. Well absorbed from GI tract but best administered on full stomach to avoid GI upset.
Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS)
Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.
Cefixime (Suprax)
By binding to one or more of the penicillin-binding proteins, arrests bacterial cell wall synthesis and inhibits bacterial growth.
Cefuroxime Axetil (Ceftin)
Second-generation cephalosporin that maintains gram-positive activity of first-generation cephalosporins; adds activity against Proteus mirabilis, H influenzae, E coli, Klebsiella pneumoniae, and M catarrhalis.
Condition of patient, severity of infection, and susceptibility of microorganism determine proper dose and route of administration.
Cefprozil (Cefzil)
Binds to one or more of the penicillin-binding proteins, which, in turn, inhibits cell wall synthesis and results in bactericidal activity.
Cefpodoxime (Vantin)
Indicated for management of infections caused by susceptible mixed aerobic-anaerobic microorganisms.
Cefdinir (Omnicef)
Third-generation cephalosporin indicated for treatment of uncomplicated skin infections.
Clindamycin (Cleocin HCl)
Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Clarithromycin (Biaxin)
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Azithromycin (Zithromax)
Broad-spectrum macrolide antibiotic. Absorption markedly reduced when taken with food.
Ceftriaxone (Rocephin)
Third-generation cephalosporin. Manufacturer has heavily promoted IM use of this drug to physicians and directly to the public for routine treatment of AOM. Subsequently, MDRSP resistance has emerged, making this less effective in many communities. Author believes this drug is best reserved for IV use for management of severe infections. Avoid widespread use for AOM.
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Healthy tympanic membrane.
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Tympanic membrane of a person with 12 hours of ear pain, slight tympanic membrane bulge, and slight meniscus of purulent effusion at bottom of tympanic membrane. Reproduced with permission from Isaacson G: The natural history of a treated episode of acute otitis media. Pediatrics. 1996; 98(5): 968-7.
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Drawing of normal right tympanic membrane. Note outward curvature of pars tensa (*) of eardrum. Tympanic annulus is indicated anteriorly (a), inferiorly (i), and posteriorly (P). M = long process of malleus; I = incus; L = lateral (short) process of malleus.
