From the Guidelines
For uncomplicated acute otitis media (AOM) in a 2-year-old child, the recommended treatment duration is 10 days of antibiotics. The first-line antibiotic treatment is typically amoxicillin at a dose of 80-90 mg/kg/day divided into two doses 1. For example, if the child weighs 12 kg, they would receive about 500 mg twice daily. If the child has a penicillin allergy, alternatives include azithromycin (10 mg/kg on day 1, then 5 mg/kg for 4 more days) or cefdinir (14 mg/kg/day divided into 1-2 doses for 10 days) 1. Some key points to consider:
- It's essential to complete the full course of antibiotics even if symptoms improve before completion.
- Pain management with acetaminophen (15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours) is also recommended.
- The 10-day duration is specifically recommended for children under 2 years because they have higher rates of treatment failure and recurrence compared to older children, for whom shorter courses may sometimes be appropriate 1.
- Follow-up is advised if symptoms don't improve within 48-72 hours of starting antibiotics 1. The optimal duration of therapy for patients with AOM is uncertain, but the recommended 10-day course is based on the best available evidence and expert opinion 1.
From the FDA Drug Label
For acute otitis media, the recommended dose of azithromycin for oral suspension for the treatment of pediatric patients is 30 mg/kg given as a single dose or 10 mg/kg once daily for 3 days or 10 mg/kg as a single dose on the first day followed by 5 mg/kg/day on Days 2 through 5. The recommended duration of treatment for uncomplicated acute otitis media in a 2-year-old patient is:
- 1 day (single dose)
- 3 days
- 5 days 2
From the Research
Duration of Treatment for Uncomplicated AOM in 2-Year-Old
- The American Academy of Pediatrics recommends the use of high-dose amoxicillin for the treatment of acute uncomplicated otitis media (OM) 3.
- A study comparing azithromycin and amoxicillin/clavulanate for the treatment of acute otitis media in children found that azithromycin given once daily for 5 days had similar efficacy to amoxicillin/clavulanate given three times daily for 10 days 4.
- Another study found that a 5-day course of once daily azithromycin was comparable to a 10-day course of three times daily amoxicillin/clavulanate in achieving clinical cure or improvement and presumed eradication of baseline pathogens in pediatric patients with acute otitis media 5.
- The duration of treatment for uncomplicated AOM in a 2-year-old is typically 5-10 days, depending on the antibiotic used and the severity of the infection.
- A systematic review found that amoxicillin-clavulanate should be the treatment of choice for children between 6 months and 12 years of age with AOM, and the rates of AOM relapse after treatment with amoxicillin-clavulanate were comparable to those of other antimicrobials or placebo 6.