From the Guidelines
Otitis media should be managed with a focus on accurate diagnosis, watchful waiting for mild cases, and prompt treatment with antibiotics for severe or recurrent infections, as well as preventive strategies to reduce the risk of complications and improve quality of life. The management of otitis media (OM) is crucial to prevent complications and improve outcomes, particularly in children. According to the study by 1, recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media, while antibiotics can shorten symptoms and duration of middle ear effusion.
Key Considerations
- Accurate diagnosis of otitis media is essential to reduce over-diagnosis, overtreatment, and antibiotic resistance 1.
- Watchful waiting for 48-72 hours may be appropriate for older children with mild symptoms before starting antibiotics 1.
- Pain management with acetaminophen or ibuprofen is important for symptomatic relief 1.
- Preventive strategies, such as pneumococcal vaccination, avoiding secondhand smoke, breastfeeding infants, and limiting pacifier use after 6 months, can reduce the risk of recurrent infections 1.
- Ear tubes (tympanostomy tubes) may be recommended for recurrent infections or persistent fluid 1.
Treatment Options
- Antibiotics, such as amoxicillin, are recommended for children under 2 years, those with severe symptoms, or bilateral infections 1.
- Topical antibiotic is the treatment of choice in acute tube otorrhea 1.
- Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes 1.
Quality of Life
- Otitis media can have a significant impact on quality of life, particularly in children, with potential effects on language, behavior, and progress at school 1.
- Effective management of otitis media can improve outcomes and reduce the risk of complications, such as hearing loss and life-long sequelae 1.
From the FDA Drug Label
Safety and efficacy using azithromycin 30 mg/kg given over 3 days Protocol 4 In a double-blind, controlled, randomized clinical study of acute otitis media in pediatric patients from 6 months to 12 years of age, azithromycin (10 mg/kg per day for 3 days) was compared to amoxicillin/clavulanate potassium (7:1) in divided doses q12h for 10 days Each patient received active drug and placebo matched for the comparator. For the 366 patients who were evaluated for clinical efficacy at the Day 12 visit, the clinical success rate (i.e., cure plus improvement) was 83% for azithromycin and 88% for the control agent. For the 362 patients who were evaluated at the Day 24 to 28 visit, the clinical success rate was 74% for azithromycin and 69% for the control agent.
- Clinical Success Rates for Azithromycin in Acute Otitis Media:
- Day 12 visit: 83%
- Day 24 to 28 visit: 74%
- Key Findings: Azithromycin is effective in treating acute otitis media in pediatric patients, with clinical success rates of 83% at Day 12 and 74% at Day 24 to 28 2.
- Main Points:
- Azithromycin is a viable treatment option for acute otitis media.
- The clinical success rates for azithromycin are comparable to those of the control agent.
From the Research
Diagnosis of Otitis Media
- Acute otitis media is diagnosed in patients with acute onset, presence of middle ear effusion, physical evidence of middle ear inflammation, and symptoms such as pain, irritability, or fever 3.
- Symptoms may include ear pain, fever, irritability, otorrhea, anorexia, and sometimes vomiting or lethargy 4.
- AOM is diagnosed in symptomatic children with moderate to severe bulging of the tympanic membrane or new-onset otorrhea not caused by acute otitis externa, and in children with mild bulging and either recent-onset ear pain or intense erythema of the tympanic membrane 4.
Treatment of Otitis Media
- Management of acute otitis media should begin with adequate analgesia 3.
- Antibiotic therapy can be deferred in children two years or older with mild symptoms 3.
- High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin 3, 5, 4.
- Children with persistent symptoms despite 48 to 72 hours of antibiotic therapy should be reexamined, and a second-line agent, such as amoxicillin/clavulanate, should be used if appropriate 3.
- For patients in whom amoxicillin is unsuccessful, second-line therapy should have demonstrated activity against penicillin-resistant S. pneumoniae as well as beta-lactamase-producing pathogens 5.
- Appropriate options for second-line therapy include high-dose amoxicillin/clavulanate and ceftriaxone 5.
Pain Relief in Otitis Media
- Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain relief in acute otitis media in children 6.
- Low quality evidence indicates that both paracetamol and ibuprofen as monotherapies are more effective than placebo in relieving short-term ear pain in children with AOM 6.
- There is insufficient evidence of a difference between ibuprofen and paracetamol in relieving short-term ear pain in children with AOM 6.