What is the most appropriate therapy for a 5-year-old boy with a left earache and a penicillin allergy?

In the case of a 5-year-old boy with an earache and a known penicillin allergy, the most appropriate therapy is azithromycin. This is important because children who present with ear infections often require antibiotic treatment, particularly when there are signs or symptoms suggesting bacterial infection.

Azithromycin, a macrolide antibiotic, is effective against common pathogens involved in otitis media, including Streptococcus pneumoniae and Haemophilus influenzae, making it a suitable alternative when amoxicillin is contraindicated due to a penicillin allergy.

Considering other options, amoxicillin is contraindicated due to the child's allergy to penicillin. While ciprofloxacin is an option in some cases, it is typically reserved for more severe infections or specific bacterial pathogens, and not for uncomplicated otitis media. Cephalosporins, while structurally similar to penicillin, may pose a risk for cross-reactivity in individuals with a penicillin allergy, particularly if the allergy is severe. Thus, azithromycin remains the safest and most effective choice in this scenario.