Acute
- symptoms < 4 weeks
- ≤ 3 episodes per year
S. pneumoniae
M. catarrhalis
H. influenzae
Occasionally:
S. aureus
Group A Streptococci
Anaerobes
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin - standard dose | 40mg/kg/d PO div tid | 10 days |
| or | ||
| Amoxicillin - high dose | 90mg/kg/d PO div bid-tid | 10 days |
Non severe penicillin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| [Clindamycin | 20-30mg/kg/d PO div tid | 10 days |
| + | ||
| Cefixime] | 8mg/kg/d PO div bid | |
| or | ||
| Cefuroxime axetil | 30mg/kg/d PO div bid | 10 days |
Severe penicillin allergy or cephalosporin allergy AND local S. pneumoniae tetracycline or TMP/SMX resistance < 20%
| Empiric Therapy | Duration | |
|---|---|---|
| Doxycycline (> 8 years old) | 4mg/kg/d PO div bid | 10 days |
| or | ||
| TMP/SMX | 8-12mg TMP/kg/d PO div bid | 10 days |
Severe/Immunocompromised
| Empiric Therapy | Duration | |
|---|---|---|
| Amoxicillin | 45mg/kg/d PO div bid-tid | 10 days |
| + | ||
|
Amoxicillin-clavulanate (7:1 - Clavulin -200 or -400) |
45mg/kg/d PO div bid-tid |
Nonsevere ß-lactam allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Ceftriaxone | 100mg/kg IV daily | 10 days |
Severe ß-lactam allergy/anaphylaxis
| Empiric Therapy | Duration | |
|---|---|---|
| Levofloxacin | 10-20mg/kg/d IV/PO div q12-24h | 10 days |