Amoxicillin for pregnant

Abstract Etiology and Risk Factors Diagnosis Management of Acute Otitis Media Management of OME Tympanostomy Tube Placement Special Populations References. Diagnosis established by physical examination findings and presence of symptoms. Children six months or older with otorrhea or severe signs or symptoms (moderate or severe otalgia, otalgia for at least 48 hours, or temperature of 102.2°F [39°C] or higher): antibiotic therapy for 10 days.

Children six to 23 months of age with bilateral acute otitis media without severe signs or symptoms: antibiotic therapy

for

Children two years or older without severe signs or symptoms: observation or antibiotic therapy for five to seven days.

Persistent symptoms (48 to 72 hours) Repeat ear examination for signs of otitis media. If otitis media is present, initiate or change antibiotic therapy.

If symptoms persist despite appropriate antibiotic therapy, consider intramuscular ceftriaxone (Rocephin), clindamycin, or tympanocentesis. Diagnosis established by physical examination findings and presence of symptoms.

Children six months or older with otorrhea or severe signs or symptoms (moderate or severe otalgia, otalgia for at least 48 hours, or temperature of 102.2°F [39°C] or higher): antibiotic therapy for 10 days. Children six to 23 months of age with bilateral acute otitis media without severe signs or symptoms: antibiotic therapy for 10 days.

Children six to 23 months of age with unilateral acute otitis media without severe signs or symptoms: observation or antibiotic therapy for 10 days. Children two years or older without severe signs or symptoms: observation or antibiotic therapy for five to seven days. Persistent symptoms (48 to 72 hours) Repeat ear examination for signs of otitis media. If otitis media is present, initiate or change antibiotic therapy.

If symptoms persist despite appropriate antibiotic therapy, consider intramuscular ceftriaxone (Rocephin), clindamycin, or tympanocentesis.

Analgesics are recommended for symptoms of ear pain, fever, and irritability.8 , 15 Analgesics are particularly important at bedtime because disrupted sleep is one of the most common symptoms motivating parents to seek care.2 Ibuprofen and acetaminophen have been shown to be effective.16 Ibuprofen is preferred, given its longer duration of action and its lower toxicity in the event of overdose.2 Topical analgesics, such as benzocaine, can also be helpful.17.

Antibiotic-resistant bacteria remain a major public health challenge.

A widely endorsed strategy for improving the management of AOM involves deferring antibiotic therapy in patients least likely to benefit from antibiotics.18 Antibiotics should be routinely prescribed for children with AOM who are six months or buy amoxicillin liquid older with severe signs or symptoms (i.e., moderate or severe otalgia, otalgia for at least 48 hours, or temperature of 102.2°F [39°C] or higher), and for children younger than two years with bilateral AOM regardless of additional signs or symptoms.8. Among children with mild symptoms, observation may be an option in those six to 23 months of age with unilateral AOM, or in those two years or older with bilateral or unilateral AOM.8 , 10 , 19 A large prospective study of this strategy found that two out of three children will recover without antibiotics.20 Recently, the American Academy of Family Physicians recommended not prescribing antibiotics for otitis media in children two to 12 years of age with nonsevere symptoms if observation is a reasonable option.21 , 22 If observation is chosen, a mechanism must be in place to ensure appropriate treatment if symptoms persist for more than 48 to 72 hours. Strategies include a scheduled follow-up visit or providing patients with a backup antibiotic prescription to be filled only if symptoms persist.8 , 20 , 23. [ corrected] Table 3 summarizes the antibiotic options for children with AOM.8 High-dose amoxicillin should be the initial treatment in the absence of a known allergy.8 , 10 , 24 The advantages of amoxicillin include low cost, acceptable taste, safety, effectiveness, and a narrow microbiologic spectrum.

Children who have taken amoxicillin in the past 30 days, who have conjunctivitis, or who need coverage for ?-lactamase–positive organisms should be treated with high-dose amoxicillin/clavulanate (Augmentin).8.

Recommended Antibiotics for (Initial or Delayed) Treatment and for Patients Who Have Failed Initial Antibiotic Therapy. Amoxicillin (80 to 90 mg/kg per day in 2 divided doses) Amoxicillin-clavulanate* (90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanate [amoxicillin to clavulanate ratio, 14:1] in 2 divided doses) Cefdinir (14 mg/kg per day in 1 or 2 doses) Cefuroxime (30 mg/kg per day in 2 divided doses) Cefpodoxime (10 mg/kg per day in 2 divided doses) Ceftriaxone (50 mg/kg IM or IV per day for 1 or 3 days, not to exceed 1 g per day) Amoxicillin-clavulanate* (90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanate in 2 divided doses) Ceftriaxone (50 mg/kg IM or IV per day for 1 or 3 days, not to exceed 1 g per day) Ceftriaxone, 3 d clindamycin (30–40 mg/kg per day in 3 divided doses), with or without third-generation cephalosporin. Clindamycin (30–40 mg/kg per day in 3 divided doses) plus third-generation cephalosporin. NOTE : Cefdinir, cefuroxime, cefpodoxime, and ceftriaxone are highly unlikely to be associated with cross-reactivity with penicillin allergy on the basis of their distinct chemical structures . *— May be considered in patients who have received amoxicillin in the previous 30 d or who have the otitis-conjunctivitis syndrome .

†— Perform tympanocentesis/drainage if skilled in the procedure, or seek a consultation from an otolaryngologist for tympanocentesis/drainage. If the tympanocentesis reveals multidrug-resistant bacteria, seek an infectious disease specialist consultation .

Reprinted with permission from Lieberthal AS, Carroll AE, Chonmaitree T, et al.

The diagnosis and management of acute otitis media .

Recommended Antibiotics for (Initial or Delayed) Treatment and for Patients Who Have Failed Initial Antibiotic Therapy. Amoxicillin (80 to 90 mg/kg per day in 2 divided doses) Amoxicillin-clavulanate* (90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanate [amoxicillin to clavulanate ratio, 14:1] in 2 divided doses) Cefdinir (14 mg/kg per day in 1 or 2 doses) Cefuroxime (30 mg/kg per day in 2 divided doses) Cefpodoxime (10 mg/kg per day in 2 divided doses) Ceftriaxone (50 mg/kg IM or IV per day for 1 or 3 days, not to exceed 1 g per day) Amoxicillin-clavulanate* (90 mg/kg per day of amoxicillin, with 6.4 mg/kg per day of clavulanate in 2 divided doses) Ceftriaxone (50 mg/kg IM or IV per day for 1 or 3 days, not to exceed 1 g per day) Ceftriaxone, 3 d clindamycin (30–40 mg/kg per day in 3 divided doses), with or without third-generation cephalosporin. Clindamycin (30–40 mg/kg per day in 3 divided doses) plus third-generation cephalosporin.

NOTE : Cefdinir, cefuroxime, cefpodoxime, and ceftriaxone are highly unlikely to be associated with cross-reactivity with penicillin allergy on the basis of their distinct chemical structures .

*— May be considered in patients who have received amoxicillin in the previous 30 d or who have the otitis-conjunctivitis syndrome .

†— Perform tympanocentesis/drainage if skilled in the procedure, or seek a consultation from an otolaryngologist for tympanocentesis/drainage. If the tympanocentesis reveals multidrug-resistant bacteria, seek an infectious disease specialist consultation .

Reprinted with permission from Lieberthal AS, Carroll AE, Chonmaitree T, et al.

The diagnosis and management of acute otitis media . Oral cephalosporins, such as cefuroxime (Ceftin), may be used in children who are allergic to penicillin.

Recent research indicates that the degree of cross reactivity between penicillin and second- and third-generation cephalosporins is low (less than 10% to 15%), and avoidance is no longer recommended.25 Because of their broad-spectrum coverage, third-generation cephalosporins in particular may have an increased risk of selection of resistant bacteria in the community.26 High-dose azithromycin (Zithromax; 30 mg per kg, single dose) appears to be more effective than the commonly used five-day course, and has a similar cure rate as high-dose amoxicillin/clavulanate.8 , 27 , 28 However, excessive use of azithromycin is associated with increased resistance, and routine use is not recommended.8 Trimethoprim/sulfamethoxazole is no longer effective for the treatment of AOM due to evidence of S. Intramuscular or intravenous ceftriaxone (Rocephin) should be reserved for episodes of treatment failure or when a serious comorbid bacterial infection is suspected.2 One dose of ceftriaxone may be used in children who cannot tolerate oral antibiotics because it has been shown to have similar effectiveness as high-dose amoxicillin.30 , 31 A three-day course of ceftriaxone is superior to a one-day course in the treatment of nonresponsive AOM caused by penicillin-resistant S. pneumoniae .31 Although some children will likely benefit from intramuscular ceftriaxone, overuse of this agent may significantly increase high-level penicillin resistance in the community.2 High-level penicillin-resistant pneumococci are also resistant to first- and third-generation cephalosporins.

Antibiotic therapy for AOM is often associated with diarrhea.8 , 10 , 32 Probiotics and yogurts containing active cultures reduce the incidence of diarrhea and should be suggested for children receiving antibiotics for AOM.32 There is no compelling evidence to support the use of complementary and alternative treatments in AOM.8. Children with persistent, significant AOM symptoms despite at least 48 to 72 hours of antibiotic therapy should be reexamined.8 If a bulging, inflamed tympanic membrane is observed, therapy should be changed to a second-line agent.2 For children initially on amoxicillin, high-dose amoxicillin/clavulanate is recommended.8 , 10 , 28.

For children with an amoxicillin allergy who do not improve with an oral cephalosporin, intramuscular ceftriaxone, clindamycin, or tympanocentesis may be considered.4 , 8 If symptoms recur more than one month after the initial diagnosis of AOM, a new and unrelated episode of AOM should be assumed.10 For children with recurrent AOM (i.e., three or more episodes in six months, or four episodes within 12 months with at least one episode during the preceding six months) with middle ear effusion, tympanostomy tubes may be considered to reduce the need for systemic antibiotics in favor of observation, or topical antibiotics for tube otorrhea.8 , 10 However, tympanostomy tubes may increase the risk of long-term tympanic membrane abnormalities and reduced hearing compared with medical therapy.33 Other strategies may help prevent recurrence (Table 4) .34 – 37.

Check for undiagnosed allergies leading to chronic rhinorrhea. The Canadian Paediatric Society gives permission to print single copies of this document from our website.

For permission to reprint or reproduce multiple copies, please see our copyright policy. Principal author(s) Tiffany Wong, Adelle Atkinson, Geert t’Jong, Michael J.

Abrams; Canadian Paediatric Society, Allergy Section.

Beta-lactam allergy is commonly diagnosed in paediatric patients, but over 90% of individuals reporting this allergy are able to

tolerate

increasing

Most patients can be safely treated with penicillin or amoxicillin if they do not have a history compatible with IgE-mediated or systemic, delayed reactions such as Stevens-Johnson syndrome (SJS), serum sickness-like reactions, drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, or acute generalized exanthematous pustulosis (AGEP). Guidance is provided on how to stratify risk of beta-lactam allergy, and on test dosing and monitoring in the outpatient setting for patients deemed low risk. Guidance for patients at higher risk of beta-lactam allergy includes criteria for appropriate referral to allergists and the use of alternative antimicrobials, such as cephalosporins, while awaiting specialist assessment. Keywords: Beta-lactam; Challenge; Drug allergy; Penicillin.

Definition and categorization of beta-lactam allergy. The World Health Organization defines drug allergy as immunologically mediated drug hypersensitivity reactions [1] . Drug allergies have historically been categorized by the Gell and Coombs system of hypersensitivity (Table 1). Clinically, drug allergies are usually classified as immediate (typically occurring within 1 hour) or non-immediate (occurring after 1 hour, but often days or weeks later) after medication initiation.

Only IgE-mediated drug allergy falls into the immediate category.

Clinical presentation of beta-lactam allergy Immune reaction Timing post-exposure Clinical presentation Type I (IgE-mediated) ?1 to 2 hours Urticaria/angioedema, respiratory distress, GI symptoms, hypotension, anaphylaxis Type II (cytotoxic) 10 hours to weeks Anemia, thrombocytopenia Type III (immune complex) 1 to 3 weeks Serum sickness-like reaction: fever, urticaria, vasculitis, arthritis/arthralgia Type IV (T cell-mediated) 2 to 14 days Maculopapular rash, Stevens-Johnson syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, acute generalized exanthematous pustulosis (AGEP) Adapted from reference 8.

Type I reactions, though rare, are concerning for many patients and practitioners.

They are unlikely to occur with the first course because exposure is required before sensitization can occur [2] .

Anaphylactic reactions to penicillin medications are rare, having been reported in [2] .

Although maculopapular exanthems associated with beta-lactams are believed to be true type IV allergy in about 5% of adults, they are far less common—and have been estimated to affect less than

2%—of

Most maculopapular exanthems in children are caused by infection and do not contraindicate further use of antibiotics [2] [3] .

Beta-lactam allergy is reported in 5% to 8% of children in North America and Europe [4] .

In paediatric patients labelled with beta-lactam allergy and referred to an allergist, 94% to 96% tolerate beta-lactam challenges upon further evaluation [3] [5] .

Paediatric patients labelled as having a beta-lactam allergy are often misdiagnosed due to misclassification of symptoms of illness or common side effects of antibiotic medications. An interaction between the antibiotic and a pathogen can sometimes mimic an allergic reaction [6] .