From the Guidelines
The best treatment for otitis media is amoxicillin, usually prescribed at 80-90 mg/kg/day divided into two doses for 5-10 days, as it is the first-line treatment for acute otitis media in children. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of accurate diagnosis and optimal management of ear pain 1. For patients allergic to penicillin, alternatives include azithromycin or clarithromycin. Pain management with acetaminophen or ibuprofen is also important for symptom relief.
Key Considerations
- The choice of antibiotic should be based on the anticipated clinical response and the microbiologic flora likely to be present 1.
- Watchful waiting is optional in mild to moderate acute otitis media, but antibiotics can shorten symptoms and duration of middle ear effusion 1.
- For otitis media with effusion (fluid without infection), watchful waiting is often recommended as most cases resolve spontaneously within 3 months 1.
- Antibiotics target the common bacterial causes including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
Treatment Options
- Amoxicillin: 80-90 mg/kg/day divided into two doses for 5-10 days
- Azithromycin: 10 mg/kg on day 1, then 5 mg/kg for 4 days
- Clarithromycin: 15 mg/kg/day divided twice daily for 10 days
- Pain management: acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours)
Further Evaluation
If symptoms worsen or don't improve within 48-72 hours of treatment, or if complications develop such as hearing loss or recurrent infections, further evaluation may be needed, potentially including referral to an otolaryngologist for consideration of tympanostomy tubes in chronic or recurrent cases 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 clinical success rate (i.e., cure plus improvement) at the Day 11 to 14 visit was 88% for azithromycin and 88% for the control agent.
The best 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.
From the Research
Treatment Options for Otitis Media
The treatment for otitis media depends on the severity and type of infection. Here are some treatment options:
- Acute otitis media is usually treated with antibiotics, with amoxicillin being the first-line treatment 3, 4, 5, 6, 7.
- For patients who are allergic to penicillin, alternative antibiotics such as trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole, cefaclor, cefuroxime axetil, and cefixime can be used 4, 6.
- In cases where the infection is resistant to amoxicillin, high-dose amoxicillin/clavulanate or other second-line agents can be used 3, 7.
- For patients with recurrent infections, antibiotic prophylaxis may be beneficial 4, 6, 7.
- Surgical procedures such as myringotomy with tympanostomy tube insertion and adenoidectomy may be necessary for patients with recurrent acute otitis media or chronic otitis media with effusion 4, 7.
Non-Antibiotic Treatment
Non-antibiotic treatment options include:
- Analgesia to manage pain and discomfort 3.
- Observation and monitoring for patients with mild symptoms 3.
- Removal of modifiable risk factors to prevent recurrent otitis media 7.
Prevention
Prevention measures include: