OTORHINOLARYNGOLOGICAL INFECTIONS

Infection/Condition and Likely Organism

Suggested Treatment

Preferred Treatment

Alternative Treatment

Tonsillitis/Pharyngitis

Group A Streptococcus

Phenoxymethylpenicillin (penicillin V) 25-50mg/kg/day PO in 4 divided doses (max. 2g/day) for 10 days

OR

Amoxicillin 50mg/kg/day PO in 3 divided doses (max. 1000-1200mg) for 10 days

Penicillin allergy (non- anaphylaxis): Cephalexin 25-50mg/kg/day PO in 2 divided doses for 10 days

OR

Erythromycin ethylsuccinate 40- 50mg/kg/day PO in 3 to 4 divided doses for 10 days

Infection/Condition and Likely Organism

Suggested Treatment

Comments

Preferred Treatment

Alternative Treatment

Rhinosinusitis

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

Group A Streptococcus

Amoxicillin 45-90mg/kg/ day in 2 divided doses PO for 10 days*

Second line:

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

Failing Amoxicillin-clavulanate:

Clindamycin 30-40mg/kg/ day PO in 3 divided doses

AND

Cefuroxime 30mg/kg/day PO in 2 divided doses

Inpatient (severe):

Ampicillin-sulbactam 100-200mg/kg/day of Ampicillin component IV in 4 divided doses (max. 8g/day)

Penicillin allergy:

Clindamycin 30-40mg/kg/ day PO in 3 or 4 divided doses.

Inpatient:

Ceftriaxone 50mg/kg/ dose IV daily

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

• Persistent illness (nasal discharge or daytime cough or both for ≥10 days without improvement) Worsening course Severe onset (concurrent fever and purulent discharge for 3 days)

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

Infection/Condition and Likely Organism

Suggested Treatment

Preferred Treatment

Alternative Treatment

Acute otitis media

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

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

<2 years old: 10 days

2-5 years old: 7 days

>5 years old: 5 days.

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

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

Penicillin allergy:

Erythromycin ethylsuccinate 15-20mg/kg/dose PO q12h

OR

Clarithromycin 7.5mg/kg/dose PO q12h

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)

OR

Azithromycin 10mg/kg/ dose PO q24h for 3 days

Infection/Condition and Likely Organism

Suggested Treatment

Comments

Preferred Treatment

Alternative Treatment

Acute otitis externa

Pseudomonas aeruginosa

Staphylococcus aureus

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 10,000 U, Neomycin sulphate 5mg and hydrocortisone 10 g 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

In Severe Cases:

As for Moderate

PLUS

Flucloxacillin 25 to 50mg/kg/day in 3 to 4 divided doses

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 upto 6 days.

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