Guidelines
Treatment Failure/Recurrence

Treatment Failure/Recurrence

Clinical Considerations

Adequate analgesia is an essential component of management of AOM

  • Recommend ibuprofen (preferred) and/or acetaminophen as needed for pain
    • Ibuprofen 10 mg/kg/dose PO q6-8h PRN (max 40 mg/kg/day)
    • Acetaminophen 10-15 mg/kg/dose PO q4h PRN (max 75 mg/kg/day)

Due to increased rates of resistance, macrolides, trimethoprim+sulfamethoxazole, and clindamycin should generally not be used first line

Dose adjustment required in renal impairment for all antimicrobials below except for cefTRIAXone

Reactions may include, but are not limited to: urticaria, angioedema, pruritus, bronchospasm, anaphylaxis

Preferred Empiric Regimen

Alternative Empiric Regimens

PLUS

  • The combination of amoxicillin+clavulanate PLUS amoxicillin is used to achieve a high dose of the amoxicillin component (i.e. 90 mg/kg), while also limiting the amount of the clavulanate component
  • Higher doses of clavulanate would not be required, and could also potentially lead to (or worsen) diarrhea

OR

  • Only if cannot tolerate oral medications

Duration of Therapy

  • AOM recurrence
  • Tympanic membrane perforation
  • Treatment failure on initial therapy

Children ≥2 years of age with NO complicating factors: 5 days

Children <2 years of age AND/OR presence of any complicating factors: 10 days