Using Ceftriaxone to treat Acute Otitis Media

[Goneril]

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It seems in the last 3-6 months I’ve seen at least 1-2 kids a month that need a course of Ceftriaxone to treat ear infections that didn’t seem to respond to oral antibiotics.

I’m only 3 years post residency. And in residency I think I probably saw a max of three kids that needed Ceftriaxone.

I practice in the suburbs of an East Coast city. Maybe the number of cases I’m seeing aren’t that significant and so I’m wondering if anyone else is seeing anything similar in their practices?

 

[SurfingDoctor]

See it in the PICU/ER all the time. Also, toddlers who are unwilling to take PO antibiotics... it was surprising to me how hard it was to get kids to take medications... until I had several.

The basic reason... easier to give with a shorter time course.

I'm willing to bet it's the population you treat.

 

[septoplasty]

So, a bit of a tanget, do many of you guys use injectables (pen or rocephin), for strep pharyngitis? The literature is spotty.. so wondering if this is an 'unofficial thing'.

 

[VA Hopeful Dr]

Nope. Once in a blue moon I'll go Bicillin (we're talking maybe 1-2x/year max) but usually the once-daily amoxicillin dosing is the way to go.

 

[SurfingDoctor]

So, a bit of a tanget, do many of you guys use injectables (pen or rocephin), for strep pharyngitis? The literature is spotty.. so wondering if this is an 'unofficial thing'.

Depends on whether the toddler will actually take PO meds or not...

 

[septoplasty]

Depends on whether the toddler will actually take PO meds or not...

Ya, in that scenario.. not tolerating PO.

 

[SurfingDoctor]

Ya, in that scenario.. not tolerating PO.

In a >2 year old toddler who spits out even the tastiest of antibiotics, because we all know as far as antibiotics go, Amoxicillin is like filet mignon, why not just give the IM shot and call it a day? Better than leaving strep inadequately treated in my opinion.

 

[septoplasty]

In a >2 year old toddler who spits out even the tastiest of antibiotics, because we all know as far as antibiotics go, Amoxicillin is like filet mignon, why not just give the IM shot and call it a day? Better than leaving strep inadequately treated in my opinion.

This is what I was asking Lol.. is it a thing, do people do this?

 

[SurfingDoctor]

This is what I was asking Lol.. is it a thing, do people do this?

As a parent of kids... heck yes.

 

[DO2015CA]

This is what I was asking Lol.. is it a thing, do people do this?

I see it all the time in the south among the community pediatricians. A lot of the time it’s kids on the spectrum who refuse textures and tastes

 

[VA Hopeful Dr]

As a parent of kids... heck yes.

I used to offer that to every parent. After probably 50 "no"s in a row, I stopped. Plus, Bicillin got weirdly expensive.

 

[SurfingDoctor]

I used to offer that to every parent. After probably 50 "no"s in a row, I stopped. Plus, Bicillin got weirdly expensive.

Ah, I don’t know about the cost. I’m surprised it’s expensive since it literally was the first antibiotic ever manufacturer, but maybe the lack of use increasing manufacturing costs.

I mean, I don’t think it’s first line by any means, but it gets the job done as a second line for those resistant toddlers. That being said, I’m not surprised there is parental refusal. I mean the number of parents that don’t want to help you restrain a kid to look in their ears or mouth or that would prefer to look the other way when their kid is flailing because they are getting an immunization and it “hurts them too much to watch” is too many to count.

 

[VA Hopeful Dr]

Ah, I don’t know about the cost. I’m surprised it’s expensive since it literally was the first antibiotic ever manufacturer, but maybe the lack of use increasing manufacturing costs.

I mean, I don’t think it’s first line by any means, but it gets the job done as a second line for those resistant toddlers. That being said, I’m not surprised there is parental refusal. I mean the number of parents that don’t want to help you restrain a kid to look in their ears or mouth or that would prefer to look the other way when their kid is flailing because they are getting an immunization and it “hurts them too much to watch” is too many to count.

1.2 million units of bicillin runs around $100 per dose wholesale these days.

Yeah its gotten to where I just have my MA restrain kids as needed as I got tired of having to tell parents that they needed to hold tighter.