Clindamycin is strong antibiotic used to treat difficult bacterial infections in children. You might see a brand name such as Cleocin on the label. It comes as liquid or capsules, and is also available as an injection or IV antibiotic.

Serious diarrhea is possible while taking in this antibiotic or during the months afterwards. This should be reported to your healthcare provider right away as treatment may be needed.

While giving clindamycin (or other antibiotics), consider also giving your child probiotics (beneficial bacteria). Out of ten well-designed studies, nine showed significantly less diarrhea in the children receiving probiotics (the studies used between 5 and 40 billion cfu per day). Probiotics are available as supplements or in some foods and beverages (yogurt, kefir, juice). Whatever you choose, look for at least 5 billion colonies.

This medicine should be taken with a full glass of water.

Liquid clindamycin should be shaken before giving each dose. To get the correct dose, skip the silverware spoon and use a measuring spoon or dose-measuring device (ask your pharmacist for one if you don’t have one). It may be stored at room temperature. Do not keep the liquid in the refrigerator. Discard any unused clindamycin 14 days after it was first prepared by the pharmacist.

Clindamycin is a recommended for children with ear infections that have not improved after 48 to 72 hours on another antibiotic and who are allergic to amoxicillin. It is usually given three or four times daily.

If your child is taking clindamycin for an ear infection, you should expect improvement within 48 to 72 hours. If not, contact your doctor to discuss other options.

Do Not use clindamycin if your child is known to be allergic to this or to any similar antibiotics such as lincomyin. Do not give clindamycin together with erythromycin. Be sure the prescribing doctor knows if your child has any other medication allergies, or has kidney disease, liver disease, intestinal disease, asthma, or eczema. Be sure to report any other medicines your child might be taking.

Get emergency care if your child is showing signs of a serious allergic reaction, such as difficulty breathing, spreading hives, or swelling of the lips, tongue, or throat.

Other side effects are possible with this or any medication. Be sure to report unexpected new symptoms to your healthcare provider. Whether they are caused by the antibiotic or by the illness getting worse, unexpected symptoms are important to report.

AAP Clinical Practice Guideline. Diagnosis and management of acute otitis media. Pediatrics, May 2004, 113(5):1451-1465.

Johnston BC, Supina AL, Ospina M, Vohra S. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004827. DOI: 10.1002/14651858.CD004827.pub2.

Clarithromycin is an antibiotic used to treat many different types of bacterial infections in children. You might see a brand name such as Biaxin on the label. It comes as liquid, tablets, or extended release tablets.

The extended release tablets should be taken with food, but the other forms are fine to take either way. If you find it upsets the stomach, taking it with food may help. Clarithromycin should be taken at least two hours before any antacids that contain magnesium or aluminum, because these can interfere with the absorption of the antibiotic.

Liquid clarithromycin should be shaken before giving each dose. To get the correct dose, skip the silverware spoon and use a measuring spoon or dose-measuring device (ask your pharmacist for one if you don’t have one). It may be stored at room temperature. Do not keep the liquid in the refrigerator. Discard any unused clarithromycin 14 days after it was first prepared by the pharmacist.

Clarithromycin is a recommended first antibiotic for some children with ear infections who are allergic to amoxicillin. It is usually given twice daily, but the extended release form may be given once daily.

If your child is taking clarithromycin for an ear infection, you should expect improvement within 48 to 72 hours. If not, contact your doctor to discuss switching to another antibiotic, such ceftriaxone or clindamycin.

Do Not use clarithromycin if your child is known to be allergic to this or to any similar antibiotics such as azithromycin or erythromcyin. Other antibiotic options might include ceftriaxone, or clindamycin. Be sure the prescribing doctor knows if your child has any other medication allergies, or has kidney disease, liver disease, or a heart rhythm problem. Be sure to report any other medicines your child might be taking.

Diarrhea is a common side effect of antibiotics. Whenever antibiotics are given, consider also giving your child probiotics (beneficial bacteria). Out of ten well-designed studies, nine showed significantly less diarrhea in the children receiving probiotics (the studies used between 5 and 40 billion cfu per day). Probiotics are available as supplements or in some foods and beverages (yogurt, kefir, juice). Whatever you choose, look for at least 5 billion colonies.

Get emergency care if your child is showing signs of a serious allergic reaction, such as difficulty breathing, spreading hives, or swelling of the lips, tongue, or throat.

Other side effects are possible with this or any medication. Be sure to report unexpected new symptoms to your healthcare provider. Whether they are caused by the antibiotic or by the illness getting worse, unexpected symptoms are important to report.

^{AAP Clinical Practice Guideline. Diagnosis and management of acute otitis media. Pediatrics, May 2004, 113(5):1451-1465.
Johnston BC, Supina AL, Ospina M, Vohra S. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004827. DOI: 10.1002/14651858.CD004827.pub2.}

Amoxicillin is an antibiotic used to treat many different types of bacterial infections in children. It does not help in viral infections such as a cold or flu. It’s often called “the pink stuff” or “the bubblegum-tasting one” by children. You might see a brand name such as Trimox, Moxatag, or Amoxil on the label. This common antibiotic comes as liquid, chewable tablets, regular tablets, and capsules. Any form can be given with or without food.

Liquid amoxicillin should be shaken before giving each dose. It’s fine to give the amoxicillin directly or to mix the medicine with another liquid if you’re fairly sure your child will drink it all. To get the correct dose, skip the silverware spoon and use a measuring spoon or dose-measuring device (ask your pharmacist for one if you don’t have one). Store it in the refrigerator between doses. It should not be allowed to freeze. Discard any unused amoxicillin 14 days after it was first prepared by the pharmacist. It may last only 7 days if stored at room temperature.

Whenever antibiotics are given, consider also giving your child probiotics (beneficial bacteria). Out of ten well-designed studies, nine showed significantly less diarrhea in the children receiving probiotics (the studies used between 5 and 40 billion cfu per day). Probiotics are available as supplements or in some foods and beverages (yogurt, kefir, juice). Whatever you choose, look for at least 5 billion colonies.

Amoxicillin is the recommended first choice antibiotic for most children with ear infections. When used to treat ear infections, the recommended dose is about 36 to 41 mg per day for each pound that the child weighs, up to a maximum of about 1500 to 1750 mg per day. This is much higher than the dose used for most other infections in children. The total daily dose is divided into two or three doses per day.

If you happen to miss a dose, you can go ahead and give it late – but try not to do two doses within about three hours of each other. If you happen to give too much at once (more than two doses), seek medical advice.

If your child is taking amoxicillin for an ear infection, you should expect improvement within 48 to 72 hours. If not, contact your doctor to discuss switching to a stronger antibiotic, such as amoxicillin-clavulanate or ceftriaxone.

Do Not use amoxicillin if your child is known to be allergic to this or to any of the penicillin-type antibiotics.

Depending on the type of allergy, other antibiotic options might include cefdinir, cefuroxime, azithromycin, or clarithromycin. Sometimes a non-itchy rash is a side effect of taking amoxicillin, and not an allergic reaction. If your child has had a rash with amoxicillin, discuss this possibility with your doctor.

Be sure the prescribing doctor knows if your child has any other medication allergies, or has mono, asthma, liver or kidney disease, or a bleeding problem. Be sure to report any other medicines your child might be taking. Get emergency care if your child is showing signs of a serious allergic reaction, such as difficulty breathing, spreading hives, or swelling of the lips, tongue, or throat. Black hairy tongue, a fairly common temporary side effect of amoxicillin, is not an allergic reaction.

Other side effects are possible with this or any medication. Be sure to report unexpected new symptoms to your healthcare provider. Whether they are caused by the antibiotic or by the illness getting worse, unexpected symptoms are important to report.

Johnston BC, Supina AL, Ospina M, Vohra S. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004827. DOI: 10.1002/14651858.CD004827.pub2.

AAP Clinical Practice Guideline. Diagnosis and management of acute otitis media. Pediatrics, May 2004, 113(5):1451-1465.

Cefdinir is an antibiotic used to treat many different types of bacterial infections in children. You might see a brand name such as Omnicef on the label. It belongs to the cephalosporin family of antibiotics (“cousins” to the penicillins). This antibiotic comes as strawberry and cream flavored liquid or as capsules.

Either form can be given with or without food. However, cefdinir should be taken at least two hours before any multivitamins with iron, iron supplements, or antacids that contain magnesium or aluminum, because these can interfere with the absorption of the antibiotic. Infant formula with iron does not pose a problem.

Liquid cefdinir should be shaken before giving each dose. To get the correct dose, skip the silverware spoon and use a measuring spoon or dose-measuring device (ask your pharmacist for one if you don’t have one). It may be stored at room temperature. Discard any unused cefdinir 10 days after it was first prepared by the pharmacist.

Cefdinir is a recommended first antibiotic for some children with ear infections who are allergic to amoxicillin. It can be taken once or twice a day. Taking the dose once a day is usually as effective as dividing the dose in two, but the smaller doses may be gentler on the stomach. If you happen to miss a twice-a-day dose, you can go ahead and give it late, but try not to give once-a-day doses within about 12 hours of each other. If you happen to give too much at once (more than two doses), seek medical advice.

If your child is taking cefdinir for an ear infection, you should expect improvement within 48 to 72 hours. If not, contact your doctor to discuss switching to another antibiotic, such ceftriaxone or clindamycin.

Do Not use cefdinir if your child is known to be allergic to this or to any of the cephalosporin antibiotics, such as cephalexin, cefuroxime, or ceftriaxone. Other antibiotic options might include azithromycin, clarithromycin, or clindamycin. Be sure the prescribing doctor knows if your child has any other medication allergies (especially to penicillins), or has kidney disease, intestinal problems. Be sure to report any other medicines your child might be taking.

Diarrhea is a common side effect of antibiotics. Whenever antibiotics are given, consider also giving your child probiotics (beneficial bacteria). Out of ten well-designed studies, nine showed significantly less diarrhea in the children receiving probiotics (the studies used between 5 and 40 billion cfu per day). Probiotics are available as supplements or in some foods and beverages (yogurt, kefir, juice). Whatever you choose, look for at least 5 billion colonies.

Get emergency care if your child is showing signs of a serious allergic reaction, such as difficulty breathing, spreading hives, or swelling of the lips, tongue, or throat.

Other side effects are possible with this or any medication. Be sure to report unexpected new symptoms to your healthcare provider. Whether they are caused by the antibiotic or by the illness getting worse, unexpected symptoms are important to report.

AAP Clinical Practice Guideline. Diagnosis and management of acute otitis media. Pediatrics, May 2004, 113(5):1451-1465.

Johnston BC, Supina AL, Ospina M, Vohra S. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004827. DOI: 10.1002/14651858.CD004827.pub2.

Ceftriaxone is a broad spectrum antibiotic that can be given by injection. It’s used to treat many different types of bacterial infections in children and is sometimes called by the brand name Rocephin. It belongs to the cephalosporin family of antibiotics (“cousins” to the penicillins). This antibiotic is only given as a shot or in an IV: it does not come in an oral form.

Ceftriaxone is a recommended first antibiotic for some children with severe ear infections who are allergic to amoxicillin and who have a high fever or severe ear pain. A child might receive one shot or three shots (one a day). Three daily shots might also be recommended as a stronger choice for a child who still has symptoms after 48 to 72 hours of another antibiotic, especially if there is a fever or severe ear pain.

If your child is given ceftriaxone for an ear infection, you should expect improvement within 48 to 72 hours. If not, contact your doctor to discuss more ceftriaxone shots, switching to another antibiotic, or draining the fluid in the ear.

Do Not use ceftriaxone if your child is known to be allergic to this or to any of the cephalosporin antibiotics, such as cephalexin, cefuroxime, or cefdinir. Other antibiotic options include amoxicillin-clavulanate or clindamycin. Be sure the prescribing doctor knows if your child has any other medication allergies (especially to penicillins), or has kidney disease, liver disease, intestinal problems, or gallbladder disease. Be sure to report any other medicines your child might be taking.

Diarrhea is a common side effect of antibiotics. Whenever antibiotics are given, consider also giving your child probiotics (beneficial bacteria). Out of ten well-designed studies, nine showed significantly less diarrhea in the children receiving probiotics (the studies used between 5 and 40 billion cfu per day). Probiotics are available as supplements or in some foods and beverages (yogurt, kefir, juice). Whatever you choose, look for at least 5 billion colonies.

Get emergency care if your child is showing signs of a serious allergic reaction, such as difficulty breathing, spreading hives, or swelling of the lips, tongue, or throat.

Other side effects are possible with this or any medication. Be sure to report unexpected new symptoms to your healthcare provider. Whether they are caused by the antibiotic or by the illness getting worse, unexpected symptoms are important to report.

AAP Clinical Practice Guideline. Diagnosis and management of acute otitis media. Pediatrics, May 2004, 113(5):1451-1465.

Johnston BC, Supina AL, Ospina M, Vohra S. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004827. DOI: 10.1002/14651858.CD004827.pub2.

Cefuroxime is an antibiotic used to treat many different types of bacterial infections in children. You might see a brand name such as Ceftin on the label. It belongs to the cephalosporin family of antibiotics (“cousins” to the penicillins). This antibiotic comes as tutti-frutti flavored liquid or as tablets. According to the manufacturer, only 5 percent of children complain about the taste of the liquid. Those who can swallow the tablets generally have no taste complaints; crushed tablets, though, taste very bitter.

If a child switches from liquid to tablets or vice versa, the milligram doses may be different: the two forms are not equivalent to each other.

Cefuroxime tablets may be taken with or without food. However, cefuroxime liquid should be taken with food. Liquid cefuroxime should be shaken before giving each dose. To get the correct dose, skip the silverware spoon and use a measuring spoon or dose-measuring device (ask your pharmacist for one if you don’t have one). It must be stored in a refrigerator. Discard any unused cefuroxime 10 days after it was first prepared by the pharmacist.

Cefuroxime is a recommended first antibiotic for some children with ear infections who are allergic to amoxicillin. It is given twice a day. If you happen to miss a dose, you can go ahead and give it late, but try not to give doses within about four hours of each other. If you happen to give too much at once (more than two doses), seek medical advice.

If your child is taking cefuroxime for an ear infection, you should expect improvement within 48 to 72 hours. If not, contact your doctor to discuss switching to another antibiotic, such ceftriaxone or clindamycin.

Do Not use cefuroxime if your child is known to be allergic to this or to any of the cephalosporin antibiotics, such as cephalexin, cefdinir, cefpodixime, or ceftriaxone. Other antibiotic options might include azithromycin, clarithromycin, or clindamycin. Be sure the prescribing doctor knows if your child has any other medication allergies (especially to penicillins), or has kidney disease, liver disease, intestinal problems, or diabetes. Be sure to report any other medicines your child might be taking.

Diarrhea is a common side effect of antibiotics. Whenever antibiotics are given, consider also giving your child probiotics (beneficial bacteria). Out of ten well-designed studies, nine showed significantly less diarrhea in the children receiving probiotics (the studies used between 5 and 40 billion cfu per day). Probiotics are available as supplements or in some foods and beverages (yogurt, kefir, juice). Whatever you choose, look for at least 5 billion colonies.

Get emergency care if your child is showing signs of a serious allergic reaction, such as difficulty breathing, spreading hives, or swelling of the lips, tongue, or throat.

Other side effects are possible with this or any medication. Be sure to report unexpected new symptoms to your healthcare provider. Whether they are caused by the antibiotic or by the illness getting worse, unexpected symptoms are important to report.

AAP Clinical Practice Guideline. Diagnosis and management of acute otitis media. Pediatrics, May 2004, 113(5):1451-1465.

Johnston BC, Supina AL, Ospina M, Vohra S. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004827. DOI: 10.1002/14651858.CD004827.pub2.

If fluid from the middle ear space is draining out of the ear in a child with an acute ear infection (acute otitis media), there must be an opening in the eardrum – the air-tight membrane that separates the middle ear from the ear canal and helps us to hear. If fluid can get out through this opening, then it makes sense that medicine might get in. Researchers at the Children’s Hospital of Pittsburgh evaluated 80 children who had acute otitis media that was draining through ear tubes that the children already had in place. Half of the children received strong oral antibiotics, twice a day for ten days; the other half received antibiotic drops directly in the ear, twice a day for seven days. Those who got oral antibiotics received about 1000 times more antibiotic than those who got the drops: 90mg of antibiotics for every kg of body weight daily (the average age child in the study would weigh a little more than 12 kg, so over 900 mg daily total); those who received drops received only 0.84 mg total every day, whether they weighed 8 kg or 38 kg.

The results appeared September 2006 in Pediatrics. Even though the drops delivered 1000 times less antibiotics, they went straight to the source of the infection, rather than being spread throughout the body. The drops were more than 25% more likely to clear the infection entirely. The drops worked on average 42% faster. The drops had dramatically fewer side effects (there was an almost 30% side effect rate from the oral antibiotics!). Beyond all of this, I am most concerned that about 10% of the patients who took oral antibiotics had already acquired new bacteria in the ear during treatment; new bacteria did not emerge in any children who received drops. Antibiotic drops worked better, faster, with fewer side effects, and less risk of developing bacterial resistance. I can’t see why for most kids with a draining ear you would choose oral antibiotics as the first line of treatment.

As many as 700,000 children each year in the United States have ear tubes placed surgically to treat chronic and recurrent fluid behind the ear drum (otitis media with effusion, or OME). A study in the December 2005 Archives of Pediatrics and Adolescent Medicine argues that young kids who get tubes are more likely to have some hearing loss 6 to 9 years later than are matched kids who did not get the tubes.

To me, this study underlines the importance of only placing tubes in kids who need them – but it is not a cause for alarm or for change in the May 2004 joint guidelines concerning which children benefit from tubes. This study looked at 125 children who had tubes placed (or not) between 1985 and 1989, when most of the tubes themselves were different (harsher) than today’s bobbin-type tubes, and the recommendations for placing them were less conservative.

The children in the study had already had fluid present in the ear for at least 3 months. Half of the children in the study were randomly assigned to get tubes and the other half were randomly assigned to get 6 months of antibiotics (common in the 1980′s). Those who were assigned to get tubes in the study had a mild average hearing loss (28.7 decibel threshold) before the tubes were placed (today we recommend tubes in otherwise healthy children when fluid has been present for at least 3 months and the hearing loss is moderate — >40 decibel threshold – a level of hearing loss we know can affect speech, language, and academic performance if allowed to persist).

Years afterwards, those in the tube group had hearing that averaged 2 to 8 decibels worse at some frequencies than did their peers in the antibiotic group (although more than half the kids in the antibiotic group were eliminated from consideration, because they ended up getting tubes anyway).

Tubes do carry with them measurable costs and risks. The key is to reserve them for those children where the benefits are likely to far outweigh the costs.

Almost one in five clinicians will give a child an antihistamine or an antihistamine-containing cold medicine to give added relief to children with ear infections. Even when they don’t, parents will often pick up an over-the-counter product on their own. Their use seems to be rising, as antibiotic use is falling.

The idea is that these should decrease congestion and unplug the Eustachian tubes, allowing the infected fluid in the ear to clear. And besides, they can make kids sleepy! Do they really help?

A beautifully designed study in the September 2003 issue of the Journal of Pediatrics concluded that antihistamines make the situation worse – lengthening the time that it takes the ear infection to go away.

I suggest giving most kids with ear infections eardrops to relieve the pain while their bodies fight the infections. This can help them sleep while they heal.

In stark contrast to some earlier studies, giving children flu vaccine does not help to prevent ear infections in young children, according to a large study published in the September 24, 2003 Journal of the American Medical Association. Earlier evidence had suggested a protective effect — perhaps a large protective effect — from the vaccine.

These earlier studies looked back at children who got the shot versus those who didn’t. Researchers at the Children’s Hospital of Pittsburgh looked more carefully at the question by choosing 786 children aged 6 months to 2 years and giving them all shots. Some received the true flu shot, others a placebo. Observers who didn’t know which child was in which group then followed the children for at least a year.

As expected, those who got the flu vaccine were less likely to get the flu. However, there was no difference between the two groups when it came to the percentage of children with at least one ear infection. There was no difference in average number of ear infections overall (either during flu season or in other parts of the year). There was no difference in length of ear infections, rounds of antibiotics prescribed, or the number of office visits to look for ear infections.

If you looked only at the older children in the study, age 19 to 24 months, the data suggested a possible decrease after the flu shot in the percentage who had at least one ear infection during the peak season (36.8% versus 54.3%) and during the following year (44.1% versus 65.7%). But the numbers were small enough in this segment that the clustering may have been entirely random.

We all want to prevent ear infections, especially in children who get them frequently. We want to decrease the rounds of antibiotics given to kids. But, while there are good reasons for children age 6 months to 2 years to get the flu vaccine, the best data we have does not support giving it to prevent ear infections.