From the Guidelines
For children with recurrent otitis media, the primary antibiotic treatment options include amoxicillin as first-line therapy at a dose of 80-90 mg/kg/day divided twice daily for 10 days, as supported by the most recent guidelines 1. When considering treatment options, it's essential to weigh the benefits and risks of antibiotic therapy. The guidelines suggest that children with recurrent AOM without persistent middle ear effusion (MEE) may not require immediate surgical intervention, and instead, can be managed with watchful waiting and antibiotic therapy as needed 1. The choice of antibiotic should be based on the severity of the infection, the child's medical history, and the likelihood of resistance. For penicillin-allergic patients, alternatives include cefdinir, cefuroxime, or azithromycin 1. In cases of treatment failure, options include high-dose amoxicillin-clavulanate, ceftriaxone, or clindamycin. For truly recurrent cases, prophylactic antibiotics may be considered, typically half-dose amoxicillin given once daily at bedtime for up to 6 months 1. Some key points to consider when treating children with recurrent otitis media include:
- Completing the full course of antibiotics even if symptoms improve quickly
- Considering tympanocentesis for culture in treatment-resistant cases
- Providing adjunctive treatments like pain management with acetaminophen or ibuprofen
- Targeting common pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis It's also important to note that topical antibiotic therapy can be effective for acute tympanostomy tube otorrhea (TTO), and can avoid the adverse events associated with systemic antibiotics 1.
From the FDA Drug Label
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 following clinical success rates were obtained from the evaluable group: Pathogen Day 11 Azithromycin Day 30 Azithromycin S. pneumoniae 61/74 (82%) 40/56 (71%) H. influenzae 43/54 (80%) 30/47 (64%) M. catarrhalis 28/35 (80%) 19/26 (73%) S pyogenes 11/11 (100%) 7/7 (100%) Overall 177/217 (82%) 97/137 (73%)
Antibiotic treatment options for children with recurrent otitis media include azithromycin.
- The clinical success rate for azithromycin in treating recurrent otitis media is around 82-83% at Day 11-12, and 71-73% at Day 30.
- Azithromycin is effective against common pathogens such as S. pneumoniae, H. influenzae, M. catarrhalis, and S. pyogenes. 2
From the Research
Antibiotic Treatment Options for Children with Recurrent Otitis Media
- Amoxicillin is the standard of therapy for infants and children with acute otitis media, as it is safe and effective for most causative bacterial pathogens 3, 4, 5.
- However, due to the emergence of bacteria resistant to amoxicillin, other antimicrobial agents such as amoxicillin-clavulanate, cefuroxime axetil, and cefixime are also recommended for treatment and prevention of otitis media 3, 4.
- For patients with recurrent acute otitis media, antimicrobial prophylaxis with amoxicillin or azithromycin can be effective in preventing frequent recurrences 5, 6.
- Azithromycin has been shown to be as effective as amoxicillin in preventing recurrent acute otitis media, with a comparable clinical response and incidence of adverse effects 6.
- High-dose amoxicillin is recommended for the treatment of acute otitis media, especially in children with recurrent episodes 7.
Surgical Options for Recurrent Otitis Media
- Tympanostomy tubes are recommended in children with recurrent acute otitis media and an abnormal ear examination at the time of clinic evaluation 7.
- Myringotomy with tympanostomy tube insertion, and adenoidectomy with myringotomy with or without tympanostomy tube insertion, are also effective surgical procedures for patients with recurrent acute otitis media and chronic otitis media with effusion 3.