Children < 6 months old with a diagnosis of AOM are beyond the scope of this guideline.
Children over 6 months who have a bulging tympanic membrane (TM), are very febrile, not responding to antipyretics, have had symptoms for > 48 hours or who had an acutely perforated tympanic membrane should receive antimicrobial therapy for AOM.
Children who have had symptoms < 48 hours, do not have a bulging TM or purulent ear discharge, are not systemically ill, have no evidence of mastoid involvement and have adequate follow-up may receive symptomatic therapy (acetaminophen or ibuprofen) for up to 48 hours.
If after 48 hours there is worsening or no improvement of clinical symptoms, oral antimicrobial therapy is recommended.
If at any time clinical symptoms worsen or patient develops high fever or symptoms or signs suggestive of complications (such as TM perforation, meningitis, mastoiditis, or sepsis), the child is to be reassessed and managed appropriately.
Contact precautions if drainage not contained by dressing
S. pyogenes (Group A Streptococcus, GAS)
Amoxicillin PO TID
High-dose Amoxicillin PO BID
*For patients who have not improved or failed therapy with Amoxicillin.
CeFURoxime axetil PO
Macrolides may result in inferior treatment efficacy compared to beta-lactam antimicrobials
10 days if < 2 years or if severe disease.
5-7 days if > 2 years and mild or moderate disease, rapid response to therapy, no known complications and appropriate follow-up assured.