Correction

Am Fam Physician. 2008 Jul 1;78(1):30.

The article “Diagnosis and Treatment of Otitis Media,” (December 1, 2007, page 1650) contained an error in Table 5 on page 1654. The dosage for acetaminophen was incorrectly listed as 1 mg per kg every six hours; the correct dosage is 15 mg per kg every six hours. The corrected Table 5 is reprinted above. The online version of this article has been corrected.

Table 5

Agents Used in the Treatment of Otitis Media

Agent Dosage Comments

Antimicrobials*

Amoxicillin

80 to 90 mg per kg per day, given orally in two divided doses

First-line drug. Safe, effective, and inexpensive

Amoxicillin/clavulanate (Augmentin)

90 mg of amoxicillin per kg per day; 6.4 mg of clavulanate per kg per day, given orally in two divided doses

Second-line drug. For patients with recurrent or persistent acute otitis media, those taking prophylactic amoxicillin, those who have used antibiotics within the previous month, and those with concurrent purulent conjunctivitis

Azithromycin (one dose; Zithromax)

30 mg per kg, given orally

For patients with penicillin allergy. One dose is as effective as longer courses

Azithromycin (three-day course; Zithromax Tri-pak)

20 mg per kg once daily, given orally

For patients with recurrent acute otitis media

Azithromycin (five-day course; Zithromax Z-pak)

5 to 10 mg per kg once daily, given orally

For patients with penicillin allergy (type 1 hypersensitivity)

Cefdinir (Omnicef)

14 mg per kg per day, given orally in one or two doses

For patients with penicillin allergy, excluding those with urticaria or anaphylaxis to penicillin (i.e., type 1 hypersensitivity)

Cefpodoxime (Vantin)

30 mg per kg once daily, given orally

For patients with penicillin allergy, excluding those with urticaria or anaphylaxis to penicillin (i.e., type 1 hypersensitivity)

Ceftriaxone (Rocephin)

50 mg per kg once daily, given intramuscularly or intravenously. One dose for initial episode of otitis media, three doses for recurrent infections

For patients with penicillin allergy, persistent or recurrent acute otitis media, or vomiting

Cefuroxime (Ceftin)

30 mg per kg per day, given orally in two divided doses

For patients with penicillin allergy, excluding those with urticaria or anaphylaxis to penicillin (i.e., type 1 hypersensitivity)

Clarithromycin (Biaxin)

15 mg per kg per day, given orally in three divided doses

For patients with penicillin allergy (type 1 hypersensitivity). May cause gastrointestinal irritation

Clindamycin (Cleocin)

30 to 40 mg per kg per day, given orally in four divided doses

For patients with penicillin allergy (type 1 hypersensitivity)

Topical agents

Ciprofloxacin/hydrocortisone (Cipro HC Otic)

3 drops twice daily

Hydrocortisone/neomycin/polymyxin B (Cortisporin Otic)

4 drops three to four times daily

Ofloxacin (Floxin Otic)

5 drops twice daily (10 drops in patients older than 12 years)

Analgesics

Acetaminophen

15 mg per kg every six hours

Antipyrine/benzocaine (Auralgan)

2 to 4 drops three to four times daily

Ibuprofen (Motrin)

10 mg per kg every six hours

Narcotic agents

Variable

May cause gastrointestinal upset, respiratory depression, altered mental status, and constipation


*— These drugs should be given for 10 days, unless otherwise indicated. A five- to seven-day course is an option for patients six years and older. These agents may cause diarrhea, vomiting, abdominal pain, rash, anorexia, and dermatitis.

†— These drugs should be used for seven to 10 days in patients with chronic suppurative otitis media.

Information from references 1, 5, and 25.

Table 5   Agents Used in the Treatment of Otitis Media

View Table

Table 5

Agents Used in the Treatment of Otitis Media

Agent Dosage Comments

Antimicrobials*

Amoxicillin

80 to 90 mg per kg per day, given orally in two divided doses

First-line drug. Safe, effective, and inexpensive

Amoxicillin/clavulanate (Augmentin)

90 mg of amoxicillin per kg per day; 6.4 mg of clavulanate per kg per day, given orally in two divided doses

Second-line drug. For patients with recurrent or persistent acute otitis media, those taking prophylactic amoxicillin, those who have used antibiotics within the previous month, and those with concurrent purulent conjunctivitis

Azithromycin (one dose; Zithromax)

30 mg per kg, given orally

For patients with penicillin allergy. One dose is as effective as longer courses

Azithromycin (three-day course; Zithromax Tri-pak)

20 mg per kg once daily, given orally

For patients with recurrent acute otitis media

Azithromycin (five-day course; Zithromax Z-pak)

5 to 10 mg per kg once daily, given orally

For patients with penicillin allergy (type 1 hypersensitivity)

Cefdinir (Omnicef)

14 mg per kg per day, given orally in one or two doses

For patients with penicillin allergy, excluding those with urticaria or anaphylaxis to penicillin (i.e., type 1 hypersensitivity)

Cefpodoxime (Vantin)

30 mg per kg once daily, given orally

For patients with penicillin allergy, excluding those with urticaria or anaphylaxis to penicillin (i.e., type 1 hypersensitivity)

Ceftriaxone (Rocephin)

50 mg per kg once daily, given intramuscularly or intravenously. One dose for initial episode of otitis media, three doses for recurrent infections

For patients with penicillin allergy, persistent or recurrent acute otitis media, or vomiting

Cefuroxime (Ceftin)

30 mg per kg per day, given orally in two divided doses

For patients with penicillin allergy, excluding those with urticaria or anaphylaxis to penicillin (i.e., type 1 hypersensitivity)

Clarithromycin (Biaxin)

15 mg per kg per day, given orally in three divided doses

For patients with penicillin allergy (type 1 hypersensitivity). May cause gastrointestinal irritation

Clindamycin (Cleocin)

30 to 40 mg per kg per day, given orally in four divided doses

For patients with penicillin allergy (type 1 hypersensitivity)

Topical agents

Ciprofloxacin/hydrocortisone (Cipro HC Otic)

3 drops twice daily

Hydrocortisone/neomycin/polymyxin B (Cortisporin Otic)

4 drops three to four times daily

Ofloxacin (Floxin Otic)

5 drops twice daily (10 drops in patients older than 12 years)

Analgesics

Acetaminophen

15 mg per kg every six hours

Antipyrine/benzocaine (Auralgan)

2 to 4 drops three to four times daily

Ibuprofen (Motrin)

10 mg per kg every six hours

Narcotic agents

Variable

May cause gastrointestinal upset, respiratory depression, altered mental status, and constipation


*— These drugs should be given for 10 days, unless otherwise indicated. A five- to seven-day course is an option for patients six years and older. These agents may cause diarrhea, vomiting, abdominal pain, rash, anorexia, and dermatitis.

†— These drugs should be used for seven to 10 days in patients with chronic suppurative otitis media.

Information from references 1, 5, and 25.


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