Guidelines
Acute otitis media

Acute otitis media

Note

The recommendations are not intended for treating children <6 months of age or for those with craniofacial abnormalities, immunocompromising conditions, tympanostomy tubes or recurrent acute otitis media (AOM).

Microbiology

Duration of therapy

Children greater than 2 years of age if no known complications: 5 days

Children less than 2 years of age, frequent, recurrent AOM, perforation or failed initially: 10 days

Preferred treatment

OR

OR

For patients who fail to respond to therapy with Amoxicillin (ie no significant improvement after 2-3 days) or present with otitis-conjunctivitis syndrome:

  • Children who have bacterial AOM should be at least somewhat better within 24 hours
  • Verify diagnosis and ensure that no complications have developed. - Discontinue amoxicillin and start amoxicillin/clavulanate (7:1 formulation)

Penicillin allergy

If the patient has NOT had a previous IgE mediated reaction to amoxicillin

OR

Cefuroxime axetil 15 mg/kg/dose PO BID
Maximum: 1 gram/24h

  • If IgE-mediated amoxicillin allergy (anaphylaxis, hypotension, urticarial and/or angioedema)
  • Streptococcus pneumoniae is increasingly becoming resistant to macrolides

If unable to tolerate PO or if treatment with amoxicillin-clavulanate fails

Referral to an otolaryngologist for tympanocentesis may be considered to determine the etiological organism to guide therapy.