What is the treatment for acute otitis media?

From the Guidelines

The treatment for acute otitis media typically involves pain management and antibiotics, with amoxicillin being the first-line treatment, usually prescribed at 80-90 mg/kg/day divided into two doses for 5-10 days. For pain relief, acetaminophen or ibuprofen should be used at appropriate doses based on the patient's weight. The choice of antibiotic should be based on the anticipated clinical response and the microbiologic flora likely to be present, with amoxicillin being effective against susceptible and intermediate resistant pneumococci 1. If the patient is allergic to amoxicillin, alternatives include cefdinir, cefpodoxime, or cefuroxime 1. Watchful waiting for 48-72 hours may be appropriate for mild cases in children over 2 years with reliable follow-up, as emphasized in recent guidelines 1. However, antibiotics are necessary because most cases are bacterial infections that can lead to complications like mastoiditis or hearing loss if untreated.

Some key points to consider in the management of acute otitis media include:

• The importance of accurate diagnosis to reduce over-diagnosis, overtreatment, and antibiotic resistance 1
• The role of topical antibiotic therapy in the treatment of acute tympanostomy tube otorrhea, which avoids adverse events associated with systemic antibiotics 1
• The need for careful consideration of the patient's history, including any recent antibiotic use or concurrent infections, when selecting an antibiotic regimen 1
• The importance of completing the full antibiotic course, even if symptoms improve quickly, to ensure effective treatment and prevent complications 1

Overall, the treatment of acute otitis media should be guided by the most recent and highest-quality evidence, with a focus on reducing morbidity, mortality, and improving quality of life. The most recent guideline update from 2022 emphasizes the importance of topical antibiotic therapy in the treatment of acute tympanostomy tube otorrhea, and highlights the need for careful consideration of the patient's history and symptoms when selecting an antibiotic regimen 1.

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 treatment for acute otitis media includes amoxicillin-clavulanate dosed at 45/6.4 mg/kg/day every 12 hours or 40/10 mg/kg/day every 8 hours for 10 days, with cure rates of 87% and 82% at the end of therapy, respectively 2.

• Clinical efficacy rates were comparable between the two dosing regimens.
• Cure rates at follow-up were 67% and 69% for the every 12 hours and every 8 hours regimens, respectively. Alternatively, ceftriaxone can be used as a single IM dose, with clinical cure rates of 74% and 58% at study days 14 and 28, respectively 3.
• Bacteriologic eradication rates were 84% and 71% for Streptococcus pneumoniae at study days 13-15 and 30+, respectively.

From the Research

Treatment for Acute Otitis Media

The treatment for acute otitis media typically involves the use of antibiotics, with amoxicillin being the most commonly recommended drug 4, 5, 6, 7.

• Amoxicillin is the drug of choice for routine empirical treatment of uncomplicated acute otitis media 4.
• High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin 5.
• For patients who have otitis media with effusion for which treatment is indicated, antimicrobial agents have been shown to be effective, with amoxicillin preferred as initial therapy 4.

Alternative Treatment Options

In cases where amoxicillin is not effective, alternative antibiotics such as trimethoprim-sulfamethoxazole, amoxicillin/clavulanate, or one of the newer oral cephalosporins may be used 4, 6, 7.

• Amoxicillin-clavulanate and cefuroxime axetil are newer agents that have been advocated for treatment and prevention of otitis media 6, 7.
• Azithromycin has also been shown to be effective in preventing recurrent acute otitis media, with a clinical response comparable to amoxicillin 8.

Surgical Methods

Surgical methods such as myringotomy with tympanostomy tube insertion, and adenoidectomy with myringotomy with or without tympanostomy tube insertion, may be considered for patients with recurrent acute otitis media and chronic otitis media with effusion 4, 6.

• The decision for or against these procedures should involve consultation with an otolaryngologist, as well as discussion with the parents and the child, if old enough, about the risks, costs, and benefits of nonsurgical and surgical management 6.