From the Guidelines
The first-line treatment for pediatric patients with otitis media is amoxicillin, as recommended by the most recent and highest quality study 1.
Common Causes of Otitis Media
The common causes of otitis media include:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Treatment for Each Cause
The treatment for each cause is as follows:
- For Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, amoxicillin is the preferred first-line treatment, typically dosed at 80-90 mg/kg/day divided into two doses for 5-7 days for uncomplicated cases in children over 2 years, and 10 days for younger children or complicated cases 1.
- For children with penicillin allergy, alternatives include azithromycin (10 mg/kg on day 1, then 5 mg/kg for 4 days) or clarithromycin (15 mg/kg/day divided twice daily for 10 days) 1.
- Pain management with acetaminophen or ibuprofen is also essential, as it helps to reduce the discomfort and fever associated with otitis media 1.
- In some cases, particularly for children over 2 years with mild symptoms, a watchful waiting approach may be appropriate for 48-72 hours before starting antibiotics, as many cases resolve spontaneously 1.
- For patients who fail initial therapy or have recurrent infections, amoxicillin-clavulanate may be used as second-line treatment to address beta-lactamase producing organisms 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.
Clinical Efficacy in Evaluable Population Study Day Ceftriaxone Single Dose Comparator – 10 days of Oral Therapy 14 74% (220/ 296) 82% (247/302) 28 58% (167/ 288) 67% (200/ 297)
The safety and effectiveness of amoxicillin and clavulanate potassium for oral suspension and chewable tablets have been established in pediatric patients
Common causes of otitis media in pediatrics include:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Treatment for each:
- Azithromycin: 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 2
- Ceftriaxone: a single IM dose compared with a 10-day course of oral antibiotic in pediatric patients between the ages of 3 months and 6 years 3
- Amoxicillin-clavulanate: the safety and effectiveness have been established in pediatric patients, with dosing modified in pediatric patients aged <12 weeks (<3 months) 4
From the Research
Common Causes of Otitis Media
- Bacterial pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, are the primary causes of otitis media 5
- Viral infections can also contribute to the development of otitis media
First-Line Treatment for Pediatric Patients with Otitis Media
- Amoxicillin is the recommended first-line antibiotic for treating uncomplicated acute otitis media in pediatric patients 6, 7, 8, 9
- Amoxicillin is effective against most causative bacterial pathogens and is safe and relatively inexpensive
Alternative Treatments for Amoxicillin Failure
- For patients who fail to respond to amoxicillin, alternative antibiotics such as amoxicillin-clavulanate, cefuroxime axetil, and cefprozil may be considered 8, 5
- The choice of alternative antibiotic should be based on factors such as the likely pathogens, antibiotic susceptibility patterns, and adverse reaction profiles
Considerations for Antibiotic Selection
- When selecting an antibiotic, physicians should consider factors such as in vitro activity, pharmacokinetics, adverse events, palatability, and cost 8
- The age of the child and the presence of any underlying medical conditions should also be taken into account when choosing an antibiotic
Treatment Duration and Dosage
- Treatment with antibiotics should typically be limited to 5-7 days, as prolonged treatment can increase the risk of resistant bacteria 7
- The dosage and frequency of antibiotic administration should be based on the specific antibiotic and the child's age and weight