What is the most appropriate antimicrobial option for a patient with acute otitis media who is allergic to penicillin?

In cases of acute otitis media, particularly when a patient has a known allergy to penicillin, azithromycin represents the most suitable alternative. Azithromycin, a macrolide antibiotic, is often utilized for treating various bacterial infections, including those of the ear, without the risk associated with penicillin-based medications for those allergic to them.

This choice is supported by established guidelines that recommend macrolides as appropriate second-line agents when treating infections in penicillin-allergic patients. Azithromycin also has a favorable safety profile and good tissue penetration, making it effective against common pathogens associated with acute otitis media.

Ciprofloxacin, while effective for certain infections, is generally not the first-line choice for acute otitis media and may not cover the typical organisms involved. Amoxicillin is a commonly prescribed antibiotic for this condition but is contraindicated here due to the patient's penicillin allergy. Cephalexin, a cephalosporin, bears structural similarities to penicillin, which can pose a risk for cross-reactivity in patients with penicillin allergies, making it a less favorable option.