What are the treatment options for acute otitis media (AOM)?

From the Guidelines

Treatment for acute otitis media (AOM) typically involves antibiotics, pain management, and supportive care, with amoxicillin being the first-line antibiotic, usually prescribed at 80-90 mg/kg/day divided twice daily for 5-10 days. For AOM, the choice of antibiotic should be based on the anticipated clinical response and the microbiologic flora likely to be present, with amoxicillin being recommended as first-line therapy due to its effectiveness against susceptible and intermediate resistant pneumococci, as well as its safety, low cost, and acceptable taste 1. If the patient has penicillin allergy, alternatives include azithromycin or clarithromycin.

For pain relief, acetaminophen or ibuprofen can be used. Watchful waiting may be appropriate for mild cases in children over 2 years with unilateral symptoms. The most recent and highest quality study on the treatment of AOM emphasizes accurate diagnosis and optimal management of ear pain, with watchful waiting being an option in mild to moderate cases 1.

Some key points to consider in the treatment of AOM include:

• The use of topical antibiotic eardrops, such as quinolone drops, for the treatment of acute tube otorrhea, which has been shown to be effective in several studies 1.
• The importance of completing the full antibiotic course, even if symptoms improve quickly, to prevent recurrence and antibiotic resistance.
• The consideration of tympanostomy tubes for children with recurrent infections, as well as the use of preventive strategies such as pneumococcal vaccination and avoiding secondhand smoke.
• The management of otitis media with effusion, which often resolves spontaneously within 3 months and typically does not require antibiotics unless symptoms persist beyond this timeframe, as outlined in the clinical practice guideline on otitis media with effusion 1.

Overall, the treatment of AOM should be guided by the most recent and highest quality evidence, with a focus on accurate diagnosis, optimal management of ear pain, and the use of effective antibiotic therapy.

From the FDA Drug Label

The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with acute otitis media is 30 mg/kg given as a single dose or 10 mg/kg once daily for 3 days or 10 mg/kg as a single dose on the first day followed by 5 mg/kg/day on Days 2 through 5.

The treatment options for acute otitis media (AOM) include:

• A single dose of 30 mg/kg of azithromycin
• 10 mg/kg once daily for 3 days of azithromycin
• 10 mg/kg as a single dose on the first day followed by 5 mg/kg/day on Days 2 through 5 of azithromycin 2 Other treatment options may be available, but they are not specified in the provided drug labels. Note that the effectiveness of these regimens may vary depending on the specific circumstances of the patient and the causative pathogen. 2, 2

From the Research

Treatment Options for Acute Otitis Media (AOM)

• The first-line treatment for uncomplicated AOM is amoxicillin 3, 4, 5, 6, 7
• For patients who do not respond to amoxicillin, alternative antibiotics such as trimethoprim-sulfamethoxazole, amoxicillin/clavulanate, or oral cephalosporins may be considered 3, 4, 5, 6
• In cases of suspected penicillin-resistant pneumococcus, high-dose amoxicillin, with or without clavulanate, or clindamycin may be used 5
• For recurrent AOM, antibiotic prophylaxis may be considered 3, 4, 5
• Tympanocentesis or myringotomy may be performed in cases of persistent or severe AOM 3, 6
• Adenoidectomy may be considered for patients with recurrent AOM 3

Antibiotic Selection

• The choice of antibiotic should be based on factors such as in vitro activity, pharmacokinetics, adverse events, palatability, and cost 6
• Amoxicillin-clavulanate combination is preferred for AOM caused by Streptococcus pneumoniae, while oral cephalosporin is preferred for AOM due to Moraxella catarrhalis and Haemophilus influenzae 7
• The decision to prescribe antimicrobial treatment as a first-line choice is based on the severity of the symptoms 7

Special Considerations

• Antibiotics are not indicated for initial treatment of otitis media with effusion, but may be considered for effusions lasting longer than 3 months 5
• Prophylactic antibiotics should be considered only for recurrent acute infections occurring three or more times within 6 months or four or more times within a year 5