What are the treatment options for antibiotic-resistant acute otitis media (AOM) infections?

Updated: Sep 25, 2019
  • Author: John D Donaldson, MD, FRCSC, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

With the emergence of resistant strains, the practitioner may need to select an alternative antimicrobial regimen that includes either a broad-spectrum beta-lactamase–resistant cephalosporin or a combined formulation such as amoxicillin-clavulanate or trimethoprim-sulfamethoxazole. Combination therapy may help prevent the emergence of resistance by mutation, provided the pathogen is initially sensitive to both components (see Medication).

With the emergence of multidrug-resistant S pneumoniae (MDRSP), oral therapy consisting of amoxicillin and amoxicillin-clavulanate may have efficacy when the total amoxicillin dose reaches 80-100 mg/kg/d.

If a child does not respond to an antibiotic within 48 hours and concurrently develops local and systemic signs of toxicity, the pathogen may be resistant to the selected drug. Treatment options include an empiric change of antimicrobial agent or a drainage procedure with culture. In children with prolonged acute symptoms, failure to improve with antibiotic therapy may indicate coexistent viral infection.


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