If a patient is allergic to penicillin, what is the recommended alternative for acute OM?

In patients with a penicillin allergy, macrolides are often recommended as an alternative treatment for acute otitis media (OM). Macrolides, such as azithromycin and erythromycin, are effective against the common pathogens associated with OM, including Streptococcus pneumoniae and Haemophilus influenzae. These antibiotics work by inhibiting bacterial protein synthesis, providing a safe and effective option for individuals who cannot tolerate penicillin.

While tetracyclines can be effective against certain bacteria, they are generally not recommended for use in young children due to the risk of dental staining and effects on growing bones. Cephalosporins, although they are structurally related to penicillin, can sometimes cross-react in individuals with penicillin allergies, making them a less desirable choice. Sulfamethoxazole has limited efficacy for this particular infection and is not typically first-line therapy for acute OM.

Therefore, the choice of a macrolide provides both safety for the patient with a penicillin allergy and the necessary antibacterial coverage.