Antibiotic | Route | Dose | Maximum daily dose |
First-line agents | |||
Communities with increased prevalence of penicillin-nonsusceptible Streptococcus pneumoniae | |||
Amoxicillin | Oral | 90 mg/kg per day in 2 doses | 3 g/day |
Amoxicillin-clavulanate*¶ | Oral | Amoxicillin 90 mg/kg per day, clavulanate 6.4 mg/kg per day in 2 doses | 3 g/day (amoxicillin component) |
Extended release amoxicillin-clavulanate (for those age ≥16 years*¶) | Oral | Amoxicillin 1 g, clavulanate 62.5 mg every 12 hours, or Amoxicillin 2 g, clavulanate 125 mg every 12 hours | 4 g/day (amoxicillin component) |
Communities with low prevalence of penicillin-nonsusceptible S. pneumoniae | |||
Amoxicillin | Oral | 40 mg/kg per day in 2 or 3 doses | 3 g/day |
Amoxicillin-clavulanate*¶ | Oral | Amoxicillin 40 mg/kg per day, clavulanate 5.7 mg/kg per day in 2 dosesΔ | 3 g/day (amoxicillin component) |
Alternatives for children with mild non-IgE-mediated reactions to penicillins (ie, without anaphylaxis, bronchospasm, or angioedema) | |||
Cefdinir | Oral | 14 mg/kg per day in 1 or 2 doses | 600 mg/day |
Cefpodoxime | Oral | 10 mg/kg per day in 2 doses | 400 mg/day |
Cefuroxime suspension (no longer available in the United States)¶ | Oral | 30 mg/kg per day in 2 doses | 1 g/day |
Cefuroxime tablets (for children who weigh >17 kg and can swallow the tablet whole) | Oral | 250 mg twice daily | |
Ceftriaxone¶ | Intramuscular or intravenous | 50 mg/kg per day | 1 g/day |
Alternatives for children with IgE-mediated or serious delayed reaction◊ to beta-lactams including cephalosporins | |||
Azithromycin | Oral | 10 mg/kg once on day 1, then 5 mg/kg once per day on days 2 through 5 | 500 mg/day on day 1; 250 mg/day on days 2 through 5 |
Clarithromycin§ | Oral | 15 mg/kg per day in 2 doses | 1 g/day |
Clindamycin | Oral | 30 mg/kg per day in 3 doses | 1.8 g/day |
AOM: acute otitis media; IgE: immunoglobulin E.
* For children at increased risk for beta-lactamase-producing nontypeable Haemophilus influenzae: those who have received a beta-lactam antibiotic (eg, penicillins, cephalosporins) in the previous 30 days, have concomitant purulent conjunctivitis, have a history of recurrent otitis media unresponsive to amoxicillin, or live in a community with high uptake of pneumococcal conjugate vaccine in children.
¶ Frequently used if amoxicillin fails.
Δ The availability of this ratio of amoxicillin to clavulanate (7:1) varies geographically.
◊ IgE-mediated reactions classically begin within 1 hour of the initial or last-administered dose; common features include anaphylaxis, angioedema, wheezing, laryngeal edema, hypotension, and hives/urticaria. Delayed reactions appear after multiple. Examples of serious delayed reactions include Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug-induced cytopenias.
§ Infrequently used because of drug interactions.