From the Guidelines
The recommended treatment for acute otitis media in children typically involves antibiotics, with amoxicillin as the first-line therapy at a dose of 80-90 mg/kg/day divided twice daily for 5-10 days. For penicillin-allergic patients, alternatives include azithromycin (10 mg/kg on day 1, then 5 mg/kg for 4 days) or amoxicillineclavulanic acid 1. Pain management is essential using acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours). Watchful waiting may be appropriate for mild cases in children over 2 years with reliable follow-up. Antibiotics are recommended because the most common bacterial causes (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) respond well to these treatments. Some key points to consider:
- The diagnosis and management of acute otitis media should be based on the best available evidence 1.
- Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain 1.
- The use of tympanostomy tubes may be considered in certain cases, such as recurrent acute otitis media or otitis media with effusion 1.
- The World Health Organization's Essential Medicines and Aware recommendations suggest amoxicillin as the first-choice antibiotic for empiric treatment of acute otitis media, with amoxicillineclavulanic acid as a second-choice option 1. Antibiotics should be prescribed for 5-10 days, depending on the severity of the case and the age of the child. Parents should be advised that symptoms typically improve within 48-72 hours of starting antibiotics, and to complete the full course even if symptoms resolve earlier. Follow-up is recommended if symptoms worsen or don't improve within 48-72 hours, as this may indicate antibiotic resistance requiring a change in therapy.
From the FDA Drug Label
2.2 Pediatric Patients 1 Infection* Recommended Dose/Duration of Therapy Acute otitis media 30 mg/kg as a single dose or 10 mg/kg once daily for 3 days or 10 mg/kg as a single dose on Day 1 followed by 5 mg/kg/day on Days 2 through 5.
The recommended treatment for acute otitis media in children is azithromycin at a dose of 30 mg/kg as a single dose or 10 mg/kg once daily for 3 days.
- Dosing options:
- 30 mg/kg as a single dose
- 10 mg/kg once daily for 3 days
- 10 mg/kg as a single dose on Day 1 followed by 5 mg/kg/day on Days 2 through 5 2
From the Research
Treatment Options for Acute Otitis Media in Children
The recommended treatment for acute otitis media in children includes:
- Antimicrobial therapy, with amoxicillin being the standard of therapy due to its safety and effectiveness against most causative bacterial pathogens 3, 4, 5
- For patients with recurrent acute otitis media or chronic otitis media with effusion, surgical procedures such as myringotomy with tympanostomy tube insertion, and adenoidectomy with myringotomy with or without tympanostomy tube insertion may be effective 3
- High-dose amoxicillin (80-90 mg/kg per day) may be necessary for children at high risk for infection with nonsusceptible Streptococcus pneumoniae, but standard-dose amoxicillin may be sufficient in areas with low prevalence of nonsusceptible strains 6
Antimicrobial Agents
Various antimicrobial agents have been advocated for the treatment and prevention of otitis media, including:
- Amoxicillin-clavulanate and cefuroxime axetil as newer agents 3, 4
- Trimethoprim-sulfamethoxazole and newer oral cephalosporins as alternatives for patients with beta-lactamase-producing bacteria 5
- Amoxicillin remains a safe and relatively inexpensive effective option for most patients 3, 4, 5
Dosage and Administration
The optimal dosage and administration schedule for amoxicillin in the treatment of acute otitis media is still a topic of debate, with some studies suggesting that once or twice daily doses may be comparable to three or four daily doses 7