TABLE 6.

Recommended Antibacterial Agents for Patients Who Are Being Treated Initially With Antibacterial Agents or Have Failed 48 to 72 Hours of Observation or Initial Management With Antibacterial Agents

Temperature ≥ 39°C and/or Severe OtalgiaAt Diagnosis for Patients Being Treated Initially With Antibacterial AgentsClinically Defined Treatment Failure at 48–72 Hours After Initial Management With Observation OptionClinically Defined Treatment Failure at 48–72 Hours After Initial Management With Antibacterial Agents
RecommendedAlternative for Penicillin AllergyRecommendedAlternative for Penicillin AllergyRecommendedAlternative for Penicillin Allergy
NoAmoxicillin, 80–90 mg/kg per dayNon-type I: cefdinir, cefuroxime, cefpodoxime; type I: azithromycin, clarithromycinAmoxicillin, 80–90 mg/kg per dayNon-type I: cefdinir, cefuroxime, cefpodoxime; type I: azithromycin, clarithromycinAmoxicillin-clavulanate, 90 mg/kg per day of amoxicillin component, with 6.4 mg/kg per day of clavulanateNon-type I: ceftriaxone, 3 days; type I: clindamycin
YesAmoxicillin-clavulanate, 90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanateCeftriaxone, 1 or 3 daysAmoxicillin, clavulanate, 90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanateCeftriaxone, 1 or 3 daysCeftriaxone, 3 daysTympanocentesis, clindamycin