TAILIEUCHUNG - Chapter 128. Pneumococcal Infections (Part 7)

Antibiotic Regimens Otitis Media (Table 128-4) Current treatment recommendations for otitis media are based on the following points: (1) Acute otitis media is the most common diagnosis leading to an antibiotic prescription in the United States. (2) The diagnosis is often based on inadequate evidence for true middle-ear infection. (3) In proven cases, S. pneumoniae and H. influenzae are the most likely causes. (4) Because penetration into a closed space may be reduced, high serum levels of an effective antibiotic are required to treat otitis caused by intermediately or fully resistant pneumococci. (5) S. pneumoniae is more likely than Haemophilus and. | Chapter 128. Pneumococcal Infections Part 7 Antibiotic Regimens Otitis Media Table 128-4 Current treatment recommendations for otitis media are based on the following points 1 Acute otitis media is the most common diagnosis leading to an antibiotic prescription in the United States. 2 The diagnosis is often based on inadequate evidence for true middle-ear infection. 3 In proven cases S. pneumoniae and H. influenzae are the most likely causes. 4 Because penetration into a closed space may be reduced high serum levels of an effective antibiotic are required to treat otitis caused by intermediately or fully resistant pneumococci. 5 S. pneumoniae is more likely than Haemophilus and much more likely than Moraxella to cause progression to serious complications without specific therapy. 6 Antibiotics that are effective against pneumococci and yet resist P-lactamases tend to be very expensive compared with amoxicillin. Table 128-4 Regimens for the Treatment of Pneumococcal Otitis Media or Sinusitis Regimen Drug Dose Duration Comments First-line Amoxicillin 1 g q8h Otitis 3-5 days after clinical response not to exceed 7 days total see text If this regimen fails try a second-line regimen. Sinusitis 7-10 days after clinical response not to exceed 2 weeks total Second- line Amoxicillin 1 g q8h plus clavulanic acid 125 mg q8hc Same as above If this regimen fails try the third-line regimen. or Fluoroquinolone or Telithromycin 800 mg d Third- line Ceftriaxone 1 g qd Otitis 3-5 days If this regimen fails consider complications. Consult an otolaryngologist and or infectious disease specialist. Sinusitis Longer

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