QUESTION 1 1. What factors are considered when making empiric antibiotic decisions? Apply those factors to a patient with suspected acute otitis media. QUESTION 2 1. A 32 year old preschool teacher complains of difficulty swallowing, sore throat, and chills. She is febrile with a temperature of 101.6 along with white patches on her tonsils. Her rapid strep test is positive. Her past medical history is positive for an anaphylactic reaction to cefaclor two years ago. What antibiotic could be safely utilized in this patient? The factors considered when prescribing antibiotics empirically include the site of infection and the organism most likely colonizing the site, prior knowledge of microorganism that is known to colonize the patient, and local bacterial resistance patterns or antibiograms of important pathogens that are available in most hospitals (Leekha et al., 2011). For a patient suspected with otitis media, the most common bacterial pathogens in the middle ear are Streptococcus pneumoniae and Haemophilus influenzae, with Moraxella catarrhalis as the third most common bacterial etiology. For adults with suspected uncomplicated otitis media, Amoxicillin is the preferred drug of choice, 875 mg PO BID or 500 mg PO TID for 5-7 days, as the said microorganisms are susceptible to it. For patients with recurrent otitis media or uncomplicated otitis media for immunicompromised patients, Amoxicillin-clavulanate 875/125 mg PO BID for 7-10 days or 10-14 days respectively. If the patient received an antibiotic in the past month, a second line of antibiotics can be used. These include cefdinir or cefuroxime which are cephalosphorins which are sensitive against gram negative bacteria. Reference Leekha, S., Terrell, C. L., & Edson, R. S. (2011). General Principles of Antimicrobial Therapy. Mayo Clinic Proceedings, 86(2), 156- 167. https://doi.org/10.4065/mcp.2010.0639 The patient with a positive rapid strep test should be treated with amoxicillin. However, Type 1 allergy to a cephalosphorin (Cefaclor) resulting to anaphylactic reaction means a penicillin should not be used. The patient can be given a macrolide like azithromycin or can be given