Phenoxymethylpenicillin (penicillin V) 25-50mg/kg/day (max. 2g/day) PO in 4 divided doses 

OR

Amoxicillin 50mg/kg/day PO in 1 or 2 divided doses (max. 1g/day) 

Duration: 10 days

Antibiotic allergy (non-life-threatening)

Cephalexin 25-50mg/kg/day (max. 2g/day) PO in 2 divided doses 

OR

Erythromycin ethylsuccinate 40-50mg/kg/day (max. 4gm/day) PO in 2 divided doses (max. 4g/day) 

Duration: 10 days

Once-daily dose amoxicillin (50 mg/kg; max:1g/day) for 10 days, is as effective as penicillin V or multiple dose amoxicillin for 10 days endorsed by the American Heart Association and the Infectious Disease Society of America in its guidelines for the treatment of GAS pharyngitis and the prevention of ARF.

Adherence is important for once-daily dosing regimens. 

Amoxicillin 80-90mg/kg/day (max.2g/day) PO for 5 days in 2 divided doses

Non-life-threatening allergy

Cefuroxime 30mg /kg/day (max. 1g/day) PO for 5 days in 2 divided doses

Severe antibiotic allergy

Erythromycin ethylsuccinate 40-50mg/kg/day (max. 4g/day) PO for 5 days in 2 divided doses

The most common causes are viral infections. Acute bacterial sinusitis is suspected when child with URI presents with:

1. Persistent illness (nasal discharge or daytime cough or both for ≥ 10 days without improvement)

2.   Worsening course

3. Severe onset (concurrent fever & purulent discharge for 3 days)

For rhinosinusitis, most experts recommend using high dose amoxicillin (90mg/kg/day).

Amoxicillin 80-90mg/kg/day (max. 3g/day) in 2 divided doses

For clinical failure, history of using amoxicillin in the last 30 days and has concurrent purulent conjunctivitis:

Amoxycillin component:

Suspension (Formulation 14:1)

Amoxicillin / Clavulanate 80-90mg/kg/day PO in 2 divided doses

Suspension (Formulation 7:1)

Amoxicillin / Clavulanate 40-45mg/kg/day PO in 2 divided doses

(max 3g/day) 

Antibiotic allergy (non-life-threatening)

Cefuroxime 30mg/kg/day (max. 1g/day) PO in 2 divided doses

Severe antibiotic allergy

Erythromycin ethylsuccinate 30-50mg/kg/day PO (max. 4g/day) in 2 divided doses

OR

Azithromycin 10mg/kg/dose PO on Day 1 (max. 500mg/day), followed by 5mg/kg/dose PO q24h on Day 2-Day 5 (max. 250mg/day) 

Most uncomplicated otitis media do not require antibiotics with certain exception: 

• children <2 years

• immunosuppression

• severe disease

Duration:

< 2yrs: 7- 10 days

> 2yrs: 5 - 7 days

90 mg/kg/day of amoxicillin, with 6.4 mg/kg/day of clavulanate, a ratio of amoxicillin to clavulanate of 14:1, given in 2 divided doses, which is less likely to cause diarrhea than other amoxicillin clavulanate preparations.

Amoxicillin/Clavulanate (40-45mg/kg/day) may not be adequate to treat AOM due to penicillin nonsusceptible S. pneumoniae

Mild to moderate:

Topical antibiotic with/without topical steroids.

E.g.:

• Gentamicin 0.3% ear drops: 3-4 drops 3 times/day for 7 days

• Polymyxin B sulphate 10,000U, neomycin sulphate 5mg & hydrocortisone 10g ear drops: 4 drops 3 or 4 times/day for 7 days

• Ofloxacin 0.3% otic solution: Instill 5 drops into affected ear(s) once daily for 7 days (Indication: for 1-12 years old)

--

Consult ORL surgeon

Ototoxic agents like gentamicin or neomycin should not be used in the presence of tympanostomy tubes or perforated tympanic membrane.

Clinical response should be seen within 48 to 72 hours, but full response may take up 6 days.

Non-response should prompt an evaluation for obstruction, presence of foreign body, non-adherence or an alternative diagnosis.

Diphtheria Antitoxin (refer to the table above)

PLUS

Erythromycin 40-50mg/kg/day IV/PO in 4 divided doses (max. 500mg/dose) for 14 days 

OR

Benzylpenicillin 100,000 – 150,000 units/kg/day in 4 divided doses (max. 1 MU/dose), followed by Phenoxymethylpenicillin (Pen V) 125-250mg PO q6h for total of 14 days of therapy (intravenous + oral)

Diphtheria Antitoxin (refer to the table above)

PLUS

Azithromycin 10mg/kg/day IV/PO OD (max 500mg/dose) for 14 days

Antibiotics are not a substitute for treatment with diphtheria antitoxin. The role of adjunctive antibiotic treatment is to eradicate C.diphtheriae, which prevents further toxin production.

IV to PO switch:

Parenteral treatment is preferred for patients unable to swallow. Once the patient improves and can swallow comfortably, switch to oral therapy. Refer to Appendix 6 for IV to PO switch.

Close contact management:

IM Benzathine Penicillin

BW < 30kg 600,000 U

BW > 30kg 1.2 MU single dose

OR

Erythromycin ethylsuccinate 40-50mg/kg/day PO q6h for 7-10 days

OR

Azithromycin 10mg/kg/day PO OD for 7-10 days 

Ceftriaxone 50-75mg/kg/dose IV daily (max.2g/dose)

OR

Cefotaxime 150-200mg/kg/day (max. 4g/day) IV in 4 divided doses

Clindamycin 30 – 40mg/kg per day IV (max. 1.8g/day) in 3 divided doses

Duration: 7 – 10 days

Switch to oral therapy (E.g.: amoxicillin/clavulanate) when improving and able to tolerate orally.