What is the recommended treatment regimen for acute otitis media?

From the Guidelines

The recommended treatment for acute otitis media is amoxicillin as the first-line therapy at a dose of 80-90 mg/kg/day divided twice daily for 5-10 days. This dosage is based on the most recent and highest quality study available, which suggests that amoxicillin is effective against susceptible and intermediate resistant pneumococci 1. The choice of amoxicillin as first-line therapy is due to its safety, affordability, and acceptable taste, as well as its narrow microbiologic spectrum 1.

For patients with penicillin allergy, alternatives such as azithromycin or clarithromycin may be considered. In cases of treatment failure or suspected resistant bacteria, amoxicillin-clavulanate may be recommended. Pain management is also essential and can include acetaminophen or ibuprofen. Watchful waiting may be appropriate for mild cases in children over 2 years with no high fever or severe symptoms.

The optimal duration of therapy for patients with AOM is uncertain, but the recommended duration is typically 5-10 days, with 5 days for mild to moderate cases in children ≥2 years and 10 days for severe cases, children <2 years, or those with recurrent infections. It is worth noting that acute otitis media is commonly caused by bacterial pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, which respond to antibiotic treatments 1.

Key points to consider when treating acute otitis media include:

• Amoxicillin as first-line therapy at a dose of 80-90 mg/kg/day divided twice daily for 5-10 days
• Alternatives for patients with penicillin allergy, such as azithromycin or clarithromycin
• Pain management with acetaminophen or ibuprofen
• Watchful waiting for mild cases in children over 2 years with no high fever or severe symptoms
• Consideration of amoxicillin-clavulanate in cases of treatment failure or suspected resistant bacteria.

From the FDA Drug Label

Based on the amoxicillin component, amoxicillin and clavulanate potassium should be dosed as follows: Patients Aged 12 weeks (3 months) and Older: Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTION | DOSING REGIMEN Otitis media, sinusitis, lower respiratory tract infections, and more severe infections | 45 mg/kg/day every 12 hours Less severe infections | 25 mg/kg/day every 12 hours b Duration of therapy studied and recommended for acute otitis media is 10 days.

The recommended treatment regimen for acute otitis media is 45 mg/kg/day every 12 hours for more severe infections and 25 mg/kg/day every 12 hours for less severe infections, with a duration of therapy of 10 days 2.

From the Research

Amoxicillin Dosing for Acute Otitis Media

• The recommended treatment regimen for acute otitis media (AOM) includes amoxicillin, with or without clavulanate, as the first-line therapy 3, 4, 5.
• High-dose amoxicillin (80-90 mg/kg/d) is recommended for the treatment of AOM, divided into twice daily doses 4, 5.
• The use of once or twice daily doses of amoxicillin, with or without clavulanate, has been shown to be comparable to three times daily doses in terms of effectiveness and adverse events 3.
• For patients who are at high risk for infection with antibiotic-resistant bacteria, high-dose amoxicillin/clavulanate (90/6.4 mg/kg/d) or other antibiotics such as cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone may be recommended 4, 5.
• The optimal duration of antibiotic treatment for AOM is still unclear, but a systematic review and network meta-analysis suggests that 7-day regimens of amoxicillin and amoxicillin-clavulanate may be noninferior to 10-day regimens in clinical responses, except for children ≤2 years old 6.
• A study comparing high-dose versus standard-dose amoxicillin for AOM found no significant difference in treatment success or adverse effects between the two groups in children at low risk for infection with antibiotic-resistant bacteria 7.

Key Considerations

• The choice of antibiotic and dosage should be based on the severity of the infection, the patient's age and weight, and the presence of any underlying medical conditions 4, 5.
• The use of pharmacokinetic/pharmacodynamic principles should be considered in selecting antibiotics for AOM 5.
• Compliance with antibiotic treatment is an important factor in the successful treatment of AOM, and factors such as taste of suspension, dosing frequency, and duration of therapy should be taken into account 4.