This protocol applies to penicillin-allergic patients with acute otitis media and myringitis whose first-line antibiotic therapy did not achieve the expected improvement within the required timeframe.
The patient has acute otitis media (AOM) with tympanic membrane involvement and a documented penicillin allergy. Oral non-penicillin cephalosporins are the standard first choice in this setting, but a subset of patients does not respond adequately to initial management.
The preceding protocol for this penicillin-allergic patient combined analgesics for ear pain, fever, and irritability — ibuprofen, acetaminophen, or topical benzocaine — with a non-penicillin antibiotic: cefdinir, cefuroxime, cefpodoxime, or ceftriaxone. In selected lower-risk children, observation with analgesia alone (deferring antibiotics) was also an option.
Escalation to the current protocol is indicated when ear pain, fever, and tympanic membrane bulging or inflammation have not resolved within 48 to 72 hours of that initial management.
Oral cephalosporins, such as cefuroxime (Ceftin), may be used in children who are allergic to penicillin.
For children with an amoxicillin allergy who do not improve with an oral cephalosporin, intramuscular ceftriaxone, clindamycin, or tympanocentesis may be considered.
If symptoms persist despite appropriate antibiotic therapy, consider intramuscular ceftriaxone (Rocephin), clindamycin, or tympanocentesis.
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