The Great Unknowns: Panel discusses research on pediatric tonsillitis, ottitis, sinusitis

While on azithromycin, the child developed fever, ear pain and headache. A rapid strep test came back negative, and the child was presumed to have a viral infection.

Three days later, the child returned to the emergency department (ED) with symptoms of otalgia, lethargy, and headache. While in the ED, the child had a seizure, and was admitted to the ICU with meningitis. Currently the child is stable, but was left with hearing loss in the left ear.

“A spinal tap showed strep pneumococcus, which in this case was sensitive to everything except azithromycin,” Dr. Haddad said. “If this child had been given standard treatment with amoxicillin or amoxicillin-clavulanate, the complication might have been avoided.”

So should antibiotics be used in children with otitis media? “The current guidelines are that antibiotics remain the mainstay for children two and under,” Dr. Haddad said. “Above age two, the practitioner has the option of observing the child to see if there’s improvement without the use of antibiotics.”

Surveillance studies show high levels of resistance to macrolides such as azithromycin. “The temptation to use macrolides is high, since they can be given once a day for five days,” Dr. Haddad said, “but because of issues related to resistance, I think it’s important for practitioners to know about potential problems.” ENTtoday