Fast Five Quiz: Antibiotic Best Practices

Mary L. Windle, PharmD


September 11, 2019

According to the CDC, watchful waiting for up to 3 days may be indicated in children with acute bacterial sinusitis who have persistent symptoms. Antibiotic therapy is recommended for children with acute bacterial sinusitis with severe or worsening disease. Amoxicillin or amoxicillin-clavulanate remains the recommended initial therapy. In children who are vomiting or who cannot tolerate oral medication, a single dose of ceftriaxone can be used and then can be switched to oral antibiotics, if the child is improving.

Mild cases of AOM with unilateral symptoms in children aged 6-23 months or unilateral or bilateral symptoms in children aged > 2 years may be appropriate for watchful waiting, per CDC guidelines. Amoxicillin remains first-line treatment for children who have not received amoxicillin within the previous 30 days. Amoxicillin-clavulanate is recommended if amoxicillin has been taken within the past 30 days, if concurrent purulent conjunctivitis is present, or if the child has a history of recurrent AOM that is unresponsive to amoxicillin. Prophylactic antibiotics are not recommended to reduce the frequency of recurrent AOM.

The CDC does not recommend the use of antibiotics in pediatric patients with bronchiolitis. Nasal suctioning is mainstay of therapy. Neither albuterol nor nebulized racemic epinephrine should be administered to infants and children with bronchiolitis who are not hospitalized. No evidence supports routine suctioning of the lower pharynx or larynx (deep suctioning) in these patients. Corticosteroids, ribavirin, and chest physiotherapy have no role in bronchiolitis.

Duration of therapy should be 7-14 days in children aged 2-24 months with a urinary tract infection, according to CDC guidelines. Initial antibiotic treatment should be based on local antimicrobial susceptibility patterns. Suggested agents include trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, cefixime, cefpodoxime, cefprozil, or cephalexin. Antibiotic treatment of asymptomatic bacteriuria in pediatric patients is not recommended.

Read more about the medical treatment of pediatric sinusitis.

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