Otoscopic criteria: Middle ear effusion AND inflammation (bulging, red/ yellow tympanic membrane (TM)) OR acute perforation of TM.
AOM will often resolve spontaneously over 24-72 h.
Mild or moderate illness: alert, responsive, responds well to analgesia, <48 hours and over 6 months can have follow-up in 24-48 hours or receive antibiotic prescription to use in if not improved in 24-48h
Infants 3-6 months or at any age with high fever, severe pain, symptoms for >48 hours, acute perforation of TM, or bilateral AOM under 2 y should be treated with antibiotics at diagnosis.
Routine Practices
Contact precautions
If drainage not contained by dressing
OR
OR
OR
*For patients who have not improved or failed therapy with Amoxicillin.
OR
Macrolides may result in inferior treatment efficacy compared to beta-lactam antimicrobials
10 days if < 2 years or if severe disease, AOM with perforation.
5 days if > 2 years and mild or moderate disease, uncomplicated.