From the Guidelines
The best treatment for a middle ear infection (otitis media) typically involves antibiotics, pain management, and supportive care, with amoxicillin being the first-line antibiotic, usually prescribed at 80-90 mg/kg/day for children or 500 mg three times daily for adults, for a 5-10 day course, as recommended by the most recent and highest quality study 1.
Key Considerations
- For most adults and children, amoxicillin is the preferred initial antibiotic treatment for otitis media, as it has been shown to be effective in reducing symptoms and duration of middle ear effusion 1.
- If pain is present, over-the-counter pain relievers like acetaminophen (10-15 mg/kg every 4-6 hours for children; 650 mg every 4-6 hours for adults) or ibuprofen (10 mg/kg every 6-8 hours for children; 400-600 mg every 6-8 hours for adults) can help reduce discomfort.
- Applying a warm compress to the affected ear may also provide relief.
- For severe or recurrent infections, stronger antibiotics like amoxicillin-clavulanate may be necessary, or if there's a penicillin allergy, alternatives such as azithromycin or clarithromycin can be used.
- Antibiotics work by killing the bacteria causing the infection, while pain relievers reduce inflammation and discomfort.
- It's essential to complete the full course of antibiotics even if symptoms improve, and to follow up with a healthcare provider if symptoms worsen or don't improve within 48-72 hours of starting treatment.
Special Considerations
- Tympanostomy tubes may be considered for children with chronic otitis media with effusion (OME), recurrent acute otitis media (AOM), or both, as they can improve hearing, reduce effusion prevalence, and provide a mechanism for drainage and administration of topical antibiotic therapy 1.
- Adenoidectomy may be offered to patient families in those meeting criteria for tympanostomy tube insertion who are greater than 4 years old, as it can reduce the prevalence of middle ear effusion and achieve hearing outcomes comparable to tube insertion alone 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 best treatment for otitis media (middle ear infection) is amoxicillin-clavulanate at a dose of 45/6.4 mg/kg/day divided every 12 hours for 10 days, with a cure rate of 87% at the end of therapy and 67% at follow-up 2.
- Key points:
- The cure rate for amoxicillin-clavulanate at 45/6.4 mg/kg/day every 12 hours is comparable to 40/10 mg/kg/day every 8 hours.
- Diarrhea was significantly lower in patients who received the every 12 hours regimen compared to patients who received the every 8 hours regimen.
- Alternative treatment:
- Ceftriaxone may also be considered as a treatment option for acute bacterial otitis media, with clinical cure rates of 74% and 58% at study day 14 and 28, respectively 3.
From the Research
Treatment Options for Otitis Media
- The management of acute otitis media should begin with adequate analgesia 4
- Antibiotic therapy can be deferred in children two years or older with mild symptoms 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 4, 5
- For persistent or recurrent acute otitis media, guidelines recommend high-dose amoxicillin/clavulanate, cefdinir, cefprozil, cefpodoxime, cefuroxime, or ceftriaxone 5
Bacteriologic Efficacy of Antibiotics
- Amoxicillin/clavulanate was significantly more likely to eradicate all bacterial pathogens and Haemophilus influenzae from middle ear fluid than azithromycin 6
- Amoxicillin/clavulanate was also more likely to eradicate Streptococcus pneumoniae, but the difference was not statistically significant 6
- The current amoxicillin dosing recommendation of 40 mg/kg/day is inadequate to effectively eradicate resistant Streptococcus pneumoniae, particularly during viral coinfection, and a dosing regimen of 75 to 90 mg/kg/day is recommended for AOM 7
Duration of Antibiotic Therapy
- Treatment with cefuroxime axetil suspension for 5 days is equivalent to treatment for 10 days either with the same regimen or with amoxicillin/clavulanate suspension in pediatric patients with acute otitis media 8
- A 5-day course of antibiotic therapy may be sufficient for some patients, but the decision to use a shorter course of therapy should be individualized based on the patient's clinical response and the severity of the infection 8