What is the treatment for bacterial otitis (inflammation of the middle ear) media?

From the Guidelines

The first-line treatment for bacterial otitis media is amoxicillin at a dose of 80-90 mg/kg/day. This recommendation is based on the most recent and highest quality study available, which suggests that amoxicillin is effective against susceptible and intermediate resistant pneumococci, and is safe, inexpensive, and has an acceptable taste and narrow microbiologic spectrum 1.

Key Considerations

• The choice of a first-line treatment should be based on the anticipated clinical response and the microbiologic flora likely to be present.
• If the patient is allergic to amoxicillin and the allergic reaction is not a type I hypersensitivity reaction, the physician can prescribe cefdinir, cefpodoxime, or cefuroxime.
• The optimal duration of therapy for patients with AOM is uncertain, but treatment for 5-10 days is commonly recommended.
• Pain management is essential and can include acetaminophen or ibuprofen.
• Patients should be reassessed after 48-72 hours if symptoms persist or worsen.

Pathogens and Treatment

• Bacterial otitis media is commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, with treatment aimed at these pathogens while considering local resistance patterns.
• The preferred antimicrobial agent for the patient with AOM must be active against these three major pathogens 1.
• Approximately one-third of children with AOM caused by a bacterial pathogen improve without treatment with antibacterial drugs, but antimicrobial therapy can rapidly resolve signs and symptoms of disease, sterilize the middle ear effusion, and prevent suppurative sequelae.

From the FDA Drug Label

ACUTE BACTERIAL OTITIS MEDIA Caused by Streptococcus pneumoniae, Haemophilus influenzae (including beta-lactamase producing strains) or Moraxella catarrhalis (including beta-lactamase producing strains)

• The treatment for Acute Bacterial Otitis Media is Ceftriaxone for Injection when caused by susceptible organisms such as Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 2.
• Amoxicillin-clavulanate may also be used to treat Acute Otitis Media, as it was compared to Ceftriaxone in clinical trials for this condition 2, 3.
• It is essential to note that the choice of treatment should be based on the susceptibility of the causative organism and local epidemiology.

From the Research

Treatment Options for Bacterial Otitis Media

• The first-line treatment for acute otitis media is high-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) 4, 5, 6
• For patients who are allergic to penicillin, alternative antibiotics such as trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole, cefaclor, cefuroxime axetil, and cefixime can be used 7
• For persistent or recurrent acute otitis media, guidelines recommend high-dose amoxicillin/clavulanate (90/6.4 mg/kg/d), cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone 4, 5, 6
• A single 60-mg/kg dose of azithromycin extended-release has been shown to be nearly as effective as a 10-day regimen of amoxicillin/clavulanate 90/6.4 mg/kg per day in the treatment of children with acute otitis media 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 7
• Increasing the dose of amoxicillin does not cover infection with beta-lactamase-producing pathogens; adding the beta-lactamase inhibitor clavulanate to amoxicillin or choosing a cephalosporin with good activity against S pneumoniae and good beta-lactamase stability may be necessary 4
• Key factors for enhancing compliance include the taste of the suspension, dosing frequency, and duration of therapy 4

Special Considerations

• Children with recurrent infections may benefit from antibiotic prophylaxis 7
• Referral for insertion of tympanostomy tubes is most appropriate for patients with documented language delay and/or significant medical complications 7
• Children with evidence of anatomic damage, hearing loss, or language delay should be referred to an otolaryngologist 5