From the Guidelines
For children experiencing recurrent acute otitis media, watchful waiting with pain management is recommended as the initial approach, especially in cases without persistent middle ear effusion, as evidenced by the most recent guideline update 1.
Treatment Options
The treatment of recurrent acute otitis media involves a multi-faceted approach that considers the frequency of infections, the presence of middle ear effusion, and the child's overall health status.
- Tympanostomy tubes are considered for children with recurrent acute otitis media and persistent middle ear effusion, as they can reduce the frequency of infections and improve hearing outcomes 1.
- Prophylactic antibiotics, such as amoxicillin, may be used in some cases, but their use should be carefully considered due to the risk of antibiotic resistance 1.
- Addressing risk factors, such as secondhand smoke exposure, pacifier use, and bottle-feeding position, is essential in preventing recurrent acute otitis media 1.
- Vaccinations, including pneumococcal and influenza vaccines, should be kept up to date to reduce the risk of ear infections 1.
Considerations
When considering treatment options, it is essential to weigh the benefits and risks of each approach.
- Tympanostomy tubes can provide significant benefits in reducing infection frequency and improving hearing outcomes, but they also carry risks, such as tube occlusion and persistent perforation 1.
- Adenoidectomy may be considered in some cases, particularly in children under 2 years of age, but its benefits should be carefully balanced against the risks associated with the procedure 1.
- Watchful waiting with pain management using acetaminophen or ibuprofen is a viable option for mild cases without high fever or severe symptoms, as it can reduce the risk of antibiotic resistance and minimize the need for surgical interventions 1.
Recommendations
Based on the most recent evidence, watchful waiting with pain management is recommended as the initial approach for children with recurrent acute otitis media without persistent middle ear effusion 1.
- Tympanostomy tubes should be considered for children with recurrent acute otitis media and persistent middle ear effusion.
- Prophylactic antibiotics should be used judiciously, and their use should be carefully considered due to the risk of antibiotic resistance.
- Addressing risk factors and keeping vaccinations up to date are essential in preventing recurrent acute otitis media.
From the Research
Treatment Options for Recurrent Acute Otitis Media
The treatment options for recurrent acute otitis media include:
- Systemic antibiotics, such as amoxicillin/clavulanate, cefuroxime axetil, and ceftriaxone, as recommended by a working group convened by the Centers for Disease Control 2
- Higher doses of commonly used antibiotics, such as amoxicillin-clavulanate and azithromycin, which have demonstrated high rates of clinical success 3
- Topical treatment with ear drops, recommended in cases of otorrhea from tympanostomy tubes 4
- Antimicrobial prophylaxis, which can provide effective prophylaxis for recurrent acute otitis media, but must be used with caution due to emerging antibiotic resistance 4, 5
Antibiotic Regimens
Specific antibiotic regimens that have been recommended for the treatment of recurrent acute otitis media include:
- High-dose amoxicillin (80 to 90 mg/kg/d divided twice daily) 6
- High-dose amoxicillin/clavulanate (90/6.4 mg/kg/d) 6
- Cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone 6
- Amoxicillin/clavulanate in combination with amoxicillin (high dose amoxicillin regimen, 80 to 90 mg/kg/day) 2
Prevention and Prophylaxis
Preventive measures that can be taken to reduce the burden of recurrent acute otitis media include:
- Pneumococcal conjugated vaccines, which seem to have a moderate reductive effect on overall otitis media 4
- Breastfeeding, which has a protective effect against recurrent acute otitis media 4
- Avoiding cigarette smoke exposure 4
- Adenoidectomy in children <2 years old with recurrent acute otitis media, which has been suggested to have an effect 4