Pedemy All toolsTap ear or sore throat, then answer one question at a time. You get the decision, the antibiotic choice and weight-based doses in mg and mL.
This tool covers the two most common reasons children get antibiotics: ear infection and strep throat. For the ear, it applies the AAP 2013 acute otitis media guideline. AOM is diagnosed with moderate or severe bulging of the eardrum, new otorrhea not caused by otitis externa, or mild bulging with ear pain for under 48 hours or intense redness. Without middle-ear effusion, it is not AOM. The tool then uses age, one or both ears, otorrhea and severe signs to decide between treating now and offering observation.
Severe signs are a toxic look, moderate to severe ear pain or pain for 48 hours or more, or a temperature of 39 °C or higher. Children under 2 get antibiotics for bilateral AOM. Children 2 and older with nonsevere AOM may be observed with a 48–72 hour safety net. Amoxicillin 90 mg/kg/day in two doses is first line. Use amoxicillin-clavulanate ES-600 after recent amoxicillin or with purulent conjunctivitis. Cefdinir, cefuroxime, cefpodoxime or ceftriaxone 50 mg/kg cover penicillin allergy. Treatment lasts 10 days under 2 years or with severe symptoms, 7 days at 2–5 years and 5–7 days at 6 and older.
For sore throat, the tool follows the IDSA 2012 strep guideline. Do not test when cough, runny nose, hoarseness or mouth ulcers point to a virus, and do not routinely test under 3 years. Confirm strep with a rapid antigen test, backed by throat culture in children and teens when negative. The McIsaac score is shown for reference only. Treatment is amoxicillin 50 mg/kg once daily (max 1,000 mg) for 10 days, penicillin V, or one dose of IM benzathine penicillin. For allergy, use cephalexin, cefadroxil, clindamycin or 5 days of azithromycin. Doses appear in mg and mL.
Under the AAP 2013 guideline, observation is an option for nonsevere unilateral AOM at 6–23 months and nonsevere AOM in one or both ears at 2 years and older, without otorrhea. You need a reliable way to start antibiotics if the child is worse or not better within 48–72 hours.
For AOM, use high-dose amoxicillin: 80–90 mg/kg/day in two doses. This tool uses 45 mg/kg per dose, up to 2,000 mg per dose. For strep, use 50 mg/kg once daily (max 1,000 mg) or 25 mg/kg twice daily (max 500 mg per dose) for 10 days.
Usually not. IDSA advises against testing when cough, rhinorrhea, hoarseness or oral ulcers suggest a virus. It also advises against routine testing under age 3. If the rapid test is negative in a child or teen, send a backup throat culture.
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