What is the treatment for otitis media?

From the Guidelines

The treatment for otitis media typically involves antibiotics, pain management, and supportive care, with amoxicillin being the first-line antibiotic, usually prescribed at 80-90 mg/kg/day divided into two doses for 5-10 days, as recommended by the American Academy of Pediatrics and American Academy of Family Physicians 1.

Key Considerations

• For acute otitis media, the dosage of amoxicillin should be 80 to 90 mg per kg per day, based on extrapolation from microbiologic studies and expert opinion, with preponderance of benefit over risk 1.
• If the patient has penicillin allergy, alternatives include cefdinir, cefpodoxime, or cefuroxime, as they are safe, inexpensive, and have an acceptable taste and narrow microbiologic spectrum 1.
• For pain relief, acetaminophen or ibuprofen can be used, with the goal of reducing inflammation and discomfort until the infection clears.
• In cases of treatment failure or amoxicillin-resistant infections, amoxicillin-clavulanate is recommended, as it provides a broader spectrum of coverage and is effective against resistant organisms.

Otitis Media with Effusion

• For otitis media with effusion (fluid without infection), watchful waiting for 3 months is often appropriate, as many cases resolve spontaneously, and medical treatment does not work well 1.
• During this period, patients should stay well-hydrated and can use warm compresses on the affected ear for comfort.
• If the fluid persists for more than 3 months, or if there are signs of hearing loss or developmental delays, further evaluation and treatment may be necessary, including the possibility of tympanostomy tubes or adenoidectomy 1.

Tympanostomy Tubes

• Tympanostomy tube insertion is a common procedure for treating otitis media with effusion, and is usually recommended for children with persistent fluid, hearing loss, or developmental delays 1.
• The procedure involves the insertion of a small tube into the eardrum, which allows air to enter the middle ear and helps to drain fluid.
• While there are risks associated with tympanostomy tube insertion, including otorrhea, tympanosclerosis, and perforation, the benefits of improved hearing and reduced risk of complications often outweigh these risks 1.

From the FDA Drug Label

The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with acute otitis media 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.

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.

The combined clinical success rate (i.e., cure and improvement) at the Day 11 visit was 84% for azithromycin.

The combined clinical success rate (i.e., cure and improvement) of those patients with a baseline pathogen at the Day 11 visit was 88% for azithromycin vs. 100% for control; at the Day 30 visit, the clinical success rate was 82% for azithromycin vs. 80% for control.

The treatment for otitis media is azithromycin, with a recommended dose of 30 mg/kg given as a single dose or 10 mg/kg once daily for 3 days. The clinical success rate for azithromycin in treating otitis media is around 83-88% 2, 2, 2.

• Key points:
  • Azithromycin is effective in treating otitis media
  • Recommended dose is 30 mg/kg given as a single dose or 10 mg/kg once daily for 3 days
  • Clinical success rate is around 83-88%
• Main considerations:
  • Azithromycin is a suitable treatment option for pediatric patients with acute otitis media
  • The dosage and administration of azithromycin should be followed as recommended to ensure effectiveness and minimize adverse events.

From the Research

Treatment Options for Otitis Media

• The treatment for otitis media includes antimicrobial therapy, with amoxicillin being an appropriate choice for first-line therapy 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, with options including high-dose amoxicillin/clavulanate and ceftriaxone 3.
• Azithromycin has been associated with a decreased risk of failure overall compared to amoxicillin, but was more associated with treatment failure in the first 3 days of treatment 4.
• Analgesic treatment, including paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs), is regarded as the cornerstone of otitis media management, with paracetamol and ibuprofen as monotherapies may be more effective than placebo in relieving short-term ear pain in children with otitis media 5.

Pain Relief in Otitis Media

• Paracetamol may be more effective than placebo in relieving pain at 48 hours, with a proportion of children with pain of 10% versus 25% 5.
• Ibuprofen may be more effective than placebo in relieving pain at 48 hours, with a proportion of children with pain of 7% versus 25% 5.
• The evidence is very uncertain about the effect of ibuprofen versus paracetamol in relieving short-term ear pain in children with otitis media, as well as for the effectiveness of ibuprofen plus paracetamol versus paracetamol alone 5.

Antibiotic Therapy

• Amoxicillin remains an effective first-line drug for treating first episodes of otitis media 4.
• Cefprozil was more likely to be associated with post-therapy failures compared to amoxicillin, while azithromycin was less likely to be associated with post-therapy failures 4.
• The pneumococcal conjugate vaccine should be administered to all children less than 2 years old and those at risk for recurrent otitis media, such as those in day care attendance or with siblings with a history of recurrent otitis media 3.