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Clinical Practice Guideline: Sinusitis in Kids

Posted Aug 14 2013 12:00am

Empiric therapeutic regimens for acute otitis media in children are outlined below, including general recommendations, first- and second-line treatments, treatment for penicillin-allergic patients, and treatments for patients with recurrent illness or treatment failures. [1, 2, 3, 4, 5, 6, 7]
General recommendations Adequate pain and fever control with either oral  acetaminophen  or  ibuprofen  or topical pain control with topical benzocaine  preparations is imperative whether antibiotics are given or not.
Age < 6mo:
Should receive antibiotics whether the diagnosis of acute otitis media is certain or not Age 6mo to 2y: Should receive antibiotics if the diagnosis is certain If the diagnosis is uncertain, an observation period can be considered if the illness is nonsevere Age > 2y: Should receive antibiotics if the diagnosis is certain and if the illness is severe An observation period is advised if the diagnosis is uncertain or if it is certain and nonsevere First-line treatment Amoxicillin  80-90 mg/kg/day PO (maximum 3 g/24h) divided BID for 5-7d; 10d may be required if illness is severe or Ceftriaxone  50 mg/kg IM × 1 dose (maximum 1 g); recommended for children unable to take antibiotics PO and for patients with compliance issues Children with acute otitis media with tympanostomy tubes: Ciprofloxacin 0.3%/dexamethasone 0.1%  otic solution 4 drops BID × 7d or Ofloxacin otic  solution 5 drops BID × 10d Second-line treatment Penicillin allergic: Non – type-1 hypersensitivity:
Cefdinir  14 mg/kg/day (maximum 600 mg/24h) PO qd or divided BID for 5-10d or
Cefpodoxime  10 mg/kg/day (maximum 400 mg/24h) PO qd or divided BID for 5-10d or
Cefuroxime  30 mg/kg/day PO (maximum 1 g/24h) divided BID for 5-10d
Type-1 hypersensitivity:
Azithromycin  10 mg/kg/day (maximum 500 mg) PO × 1 dose, then 5 mg/kg/day (maximum 250 mg/24h) PO qd × 4d or
Azithromycin 10 mg/kg/day (maximum 500 mg/24h) PO qd × 3d or
Clarithromycin  15 mg/kg/day (maximum 1 g/24h) PO divided BID for 5-10d
Recurrent acute otitis media/treatment failure Amoxicillin-clavulanate  90 mg/kg/day (based on amoxicillin component using ES formulation; maximum 4 g/24h) PO divided BID for 5-7d or Cefdinir 7 mg/kg q12h or 14 mg/kg q24h for 5-7d or Cefpodoxime 10 mg/kg/day as a single dose or Cefprozil  15 mg/kg q12h for 5-7d or Cefuroxime 30 mg/kg/day divided q12h for 5-7d or Ceftriaxone 50 mg/kg qd IM (maximum 1 g/24h) for 3d Persistent treatment failure Ceftriaxone 50 mg/kg qd IM (maximum 1 g/24h) for 3d or Clindamycin  20-30 mg/kg/day divided QID for 5-7d
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