Physical exam reveals signs of URI.

Tympanogram: compliance <0.1 cc., gradient > 150 daPa.

No prior episodes of AOM.

What would be your standard treatment of an eight-month-old who is experiencing his first episode of AOM?

At present, amoxicillin remains the antibiotic of first choice for treatment of uncomplicated acute otitis media. The drug is effective against the majority of the 3 most common bacteria causing AOM (S. pneumoniae, H. influenzae, and M. catarrhalis), has lower side effects, low cost, and is palatable.

Standard recommended dose of amoxicillin is 25-50 mg/Kg/day. Administration of amoxicillin in standard dose achieves peak middle ear fluid concentrations in the range of 1 to 6 ug/ml, which might be expected to fail to eradicate drug resistant Streptococcus pneumoniae (DRSP) in some cases. However, no oral antimicrobial agent currently available would be expected to consistently eradicate penicillin sensitive S. pneumoniae better than amoxicillin.

High dose amoxicillin (80 – 90 mg/Kg/day) is recommended to be used initially only when the child is at high risk for having infection caused by DRSP, such as patients who have received antibiotics in the previous month, or those attend day care center.