Acute Otitis Media Treatments

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ACUTE OTITIS MEDIA TREATMENTS: NEWBORN–12 YEARS
ACUTE OTITIS MEDIA TREATMENTS: NEWBORN−12 YEARS 
Generic Brand Form Strength Flavor Dose
amoxicillin* Amoxil drops 50mg/mL bubble gum ≤12wks: Max 30mg/kg/day in 2 divided doses every 12hrs
>12wks (<40kg): 40mg/kg/day in 3 divided doses every 8hrs
Or 45mg/kg/day in 2 divided doses every 12hrs
≥40kg: as adult
Note: The AAP recommends 80−90mg/kg/day in divided doses (this is not an FDA‑approved dose)
susp 200mg/5mL, 250mg/5mL, 400mg/5mL bubble gum
chew tabs 200mg, 400mg cherry-banana-peppermint
amoxicillin + clavulanate
(clavulanate component in parentheses)
Augmen-
tin
3
susp 125mg
 (31.25mg)/
 
5mL1

 

banana <12wks: 30mg/kg/day (of amoxicillin) in 2 divided doses every 12hrs (use 125mg/5mL susp)
≥12wks (<40kg): 45mg/kg/day (of amoxicillin) in 2 divided doses every 12hrs (use 200 or 400mg/5mL susp or 200mg or 400mg chew tabs)
Or 40mg/kg/day (of amoxicillin) in 3 divided doses every 8hrs (use 125 or 250mg/5mL susp, or 250mg or 500mg chew tabs)
≥40kg: 500mg every 12hrs or 250mg every 8hrs
250mg
 (62.5mg)/
 
5mL1

 

orange
200mg
 (28.5mg)/
 
5mL2,
400mg
 (57mg)/
 
5mL2
orange-raspberry
chew tabs 125mg
 (31.25mg)1, 250mg
 (62.5mg)1

 

lemon-lime
200mg
 (28.5mg)2,
400mg
 (57mg)2
cherry-
banana
ES-600 susp 600mg
 (42.9mg)/
 
5mL
strawberry cream <3mos: Not recommended.
≥3mos (<40kg): 90mg/kg/day in 2 divided doses every 12hrs
≥40kg: use adult formulations
azithromycin Zithromax susp 100mg/5mL,
200mg/5mL
cherry-vanilla-banana <6mos: Not established.
≥6mos: 30mg/kg as a single dose (max 1.5g); or 10mg/kg (max 500mg) once daily for 3 days; or 10mg/kg (max 500mg) once then 5mg/kg (max 250mg) per day for 4 days.
cefaclor susp 125mg/5mL, 187mg/5mL, 250mg/5mL, 375mg/5mL strawberry <1mo: Not recommended.
≥1mo: 40mg/kg/day in 2 divided doses every 12hrs, or in 3 divided doses every 8hrs; max 1g/day
cefdinir susp 125mg/5mL, 250mg/5mL strawberry <6mos: Not recommended. >6mos: 14mg/kg every 24hrs for 10 days or 7mg/kg every 12hrs for 5−10 days; max 600mg/day
cefixime Suprax susp 100mg/5mL,
200mg/5mL
strawberry <6mos: Not recommended.
6mos−12yrs (<50kg): 8mg/kg once daily or 4mg/kg every 12hrs
>12yrs (>50kg): 400mg once daily
cefpodoxime susp 50mg/5mL, 100mg/5mL lemon-creme <2mos: Not recommended.
≥2mos: 5mg/kg (max 200mg) every 12hrs for 5 days
cefprozil susp 125mg/5mL, 250mg/5mL bubble gum <6mos: Not recommended.
>6mos: 30mg/kg/day in 2 divided doses every 12hrs
ceftriaxone Rocephin inj 500mg/vial,
1g/vial
N/A 50mg/kg IM once; max 1g
cefuroxime Ceftin4 susp 125mg/5mL, 250mg/5mL tutti-frutti <3mos: Not recommended.
>3mos: 30mg/kg/day in 2 divided doses; max 1g/day
Children who can swallow tablets whole: one 250mg tab twice daily
tabs 125mg, 250mg N/A
cephalexin Keflex caps 250mg, 500mg, 750mg N/A 75−100mg/kg/day in 4 divided doses
ciprofloxacin Otiprio5 otic susp 6% N/A <6mos: Not established.
>6mos: one 0.1mL (6mg) single dose into each affected ear, after effusion suctioning.
clarithro-
mycin
Biaxin susp 125mg/5mL, 250mg/5mL fruit-punch <6mos: Not established.
>6mos: 7.5mg/kg every 12hrs for 10 days
sulfameth-
oxazole (SMX) +
trimethoprim (TMP)
susp 200mg (SMX) +
40mg (TMP)/5mL
cherry, grape <2mos: Not recommended.
≥2mos: 8mg/kg of TMP (40mg/kg of SMX) per day in 2 divided doses every 12hrs for 10 days
trimethoprim Primsol soln 50mg/5mL bubble gum ≥6mos: 10mg/kg daily in 2 divided doses every 12hrs
NOTES

Key: drops = oral drops. susp = oral suspension (as supplied or after reconstitution).

* Indicates the drug is available under other brand names not shown here.

1 These formulations are intended to be used in three-times-daily (TID) regimens. Do not substitute plain tabs for chewable tabs.

2 These formulations are intended to be used in twice-daily regimens. Do not substitute plain tabs for chewable tabs.

3 These products should be taken with food.

4 Ceftin susp and Ceftin tabs are not bioequivalent and cannot be interchanged on a mg/mg basis. Ceftin tabs can be taken without regard to meals; Ceftin susp must be taken with food.

5 For intratympanic administration only, in patients with effusion undergoing tympanostomy tube placement.

Not an inclusive list of medications, dosing regimens, formulations, and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. Information on prophylaxis of chronic otitis media infections is not included. Under certain clinical conditions (eg, impaired renal or hepatic function), the dose may need to be adjusted. Unless stated otherwise, otitis media is generally treated for 10−14 days.

(Rev. 7/2017)

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