From the Guidelines
The recommended treatment for bacterial otitis media is amoxicillin as first-line therapy, typically prescribed at 80-90 mg/kg/day divided into two doses for 5-10 days. This recommendation is based on the most recent and highest quality study available, which emphasizes the effectiveness of amoxicillin against common AOM bacterial pathogens, as well as its safety, low cost, and acceptable taste 1. For patients with penicillin allergy, alternatives include cefdinir, cefpodoxime, or cefuroxime, as the risk of cross-reactivity with penicillin is low, especially with second- and third-generation cephalosporins 1.
Key Considerations
- The choice of antibiotic should be based on the anticipated clinical response and the microbiologic flora likely to be present 1.
- Pain management with acetaminophen or ibuprofen is important for symptom relief.
- Patients should complete the full antibiotic course even if symptoms improve quickly to prevent recurrence and antibiotic resistance.
- Follow-up is advised if symptoms don't improve within 48-72 hours of starting antibiotics.
Treatment Failure
In cases of treatment failure or suspected resistant bacteria, amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component) is recommended as a second-line treatment 1. This is due to its broader spectrum of activity against beta-lactamase producing organisms, which are often responsible for treatment failure.
Quality of Life
The goal of treatment is not only to eradicate the infection but also to improve the patient's quality of life by reducing symptoms such as pain and fever, and preventing potential complications such as hearing loss or mastoiditis. Therefore, it is essential to choose an antibiotic that is effective, safe, and well-tolerated.
Recent Guidelines
Recent guidelines emphasize the importance of accurate diagnosis and optimal management of ear pain, as well as the need to reduce over-diagnosis, overtreatment, and antibiotic resistance 1. Watchful waiting may be an option in mild to moderate cases, but antibiotics can shorten the duration of symptoms and middle ear effusion.
From the FDA Drug Label
14.2 Acute Bacterial Otitis Media and Diarrhea in Pediatric Patients One U.S./Canadian clinical trial was conducted which compared 45/6. 4 mg/kg/day (divided every 12 hours) of amoxicillin and clavulanate potassium for 10 days versus 40/10 mg/kg/day (divided every 8 hours) of amoxicillin and clavulanate potassium for 10 days in the treatment of acute otitis media. The clinical efficacy rates at the end of therapy visit (defined as 2 to 4 days after the completion of therapy) and at the follow-up visit (defined as 22 to 28 days post-completion of therapy) were comparable for the 2 treatment groups, with the following cure rates obtained for the evaluable patients: At end of therapy, 87% (n = 265) and 82% (n = 260) for 45 mg/kg/day every 12 hours and 40 mg/kg/day every 8 hours, respectively. At follow-up, 67% (n = 249) and 69% (n = 243) for 45 mg/kg/day every 12 hours and 40 mg/kg/day every 8 hours, respectively.
The recommended treatment for bacterial otitis media is amoxicillin-clavulanate. The dosage is 45/6.4 mg/kg/day divided every 12 hours for 10 days, with a cure rate of 87% at the end of therapy and 67% at follow-up 2.
Alternatively, azithromycin can be used for the treatment of acute otitis media, with a total dosage regimen of 30 mg/kg 3.
From the Research
Treatment Options for Bacterial Otitis Media
The recommended treatment for bacterial otitis media typically involves the use of antibiotics. The choice of antibiotic depends on various factors, including the severity of the infection, the patient's age, and the likelihood of resistance to certain antibiotics.
First-Line Treatment
- Amoxicillin is often considered the first-line treatment for uncomplicated acute otitis media 4, 5, 6.
- High-dose amoxicillin (at least 80 mg/kg/day) is recommended for uncomplicated infections 5.
Alternative Treatments
- Amoxicillin-clavulanate is an alternative treatment option, especially when additional coverage for Haemophilus influenzae is desired 5, 7, 8.
- Ceftriaxone is another option, with a 3-day regimen increasing the probability of bacteriological eradication compared to a single dose 5.
- Other antibiotics, such as trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole, cefaclor, cefuroxime axetil, and cefixime, may be considered for resistant beta-lactamase-producing bacterial strains 6.
- Cefprozil is a potential alternative for the treatment of acute otitis media with effusion in children, with the advantage of twice-a-day dosing and lower gastrointestinal side effects 8.
Considerations for Treatment
- The choice of antibiotic should consider factors such as proven efficacy, cost, side effect profile, compliance issues, spectrum of coverage, and the age of the child 6.
- The increasing isolation of beta-lactamase-producing organisms and penicillin-resistant Streptococcus pneumoniae should be taken into account when selecting an antibiotic 4.
- The clinical efficacy of amoxicillin-clavulanate was found to be equal to azithromycin in children with acute otitis media 7.