From the Guidelines
For severe discomfort due to acute otitis media in a 5-year-old, acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) is recommended for pain management. The management of pain is crucial in acute otitis media (AOM) as it helps the child rest and recover while the immune system fights the infection 1. According to the American Academy of Pediatrics, analgesics such as acetaminophen or ibuprofen should be used to relieve pain associated with AOM, regardless of whether antibiotic therapy is prescribed 1.
The recommended dosage for acetaminophen is 10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours, while ibuprofen can be administered at 5-10 mg/kg every 6-8 hours with food to prevent stomach upset 1. For a typical 5-year-old weighing about 18-20 kg, this translates to approximately 180-300 mg of acetaminophen or 90-200 mg of ibuprofen per dose.
Some key points to consider in managing severe discomfort due to AOM include:
- Applying a warm compress to the affected ear may provide additional comfort
- If pain is severe despite these measures or persists beyond 48-72 hours, the child should be evaluated by a healthcare provider as antibiotics may be necessary
- The use of topical anesthetic drops is not recommended for treating AOM, as they may mask progression of underlying disease while pain is being suppressed 1
- Opioids such as fentanyl citrate, morphine sulfate, and hydromorphone hydrochloride are indicated for procedure-related pain and moderate to severe around-the-clock pain, but their use should be limited to mitigate risks of opioid misuse or diversion 1.
Overall, the goal of pain management in AOM is to provide adequate relief and prevent complications, while also minimizing the risk of adverse effects from medication 1.
From the FDA Drug Label
Azithromycin for oral suspension can be taken with or without food. Acute Otitis Media 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.
For a 5-year-old with severe discomfort due to acute otitis media, the recommended dose is 30 mg/kg as a single dose or 10 mg/kg once daily for 3 days.
- Based on the weight, the dose would be:
- For a 5-year-old weighing around 20 kg (44 lbs): 600 mg as a single dose or 200 mg once daily for 3 days
- For a 5-year-old weighing around 30 kg (66 lbs): 900 mg as a single dose or 300 mg once daily for 3 days However, severe discomfort is not explicitly addressed in the label, and the treatment focuses on the infection rather than the symptom of discomfort. The information provided does not directly address what to do for severe discomfort due to acute otitis media in a 5-year-old, only the dosage for the infection itself. 2
From the Research
Severe Discomfort due to Acute Otitis Media in a 5-year-old
- For a 5-year-old experiencing severe discomfort due to acute otitis media, the recommended treatment includes pain management plus observation or antibiotics, depending on the patient's age, severity of symptoms, and whether the AOM is unilateral or bilateral 3.
- High-dose amoxicillin (80 to 90 mg per kg per day in two divided doses) is first-line therapy unless the patient has taken amoxicillin for AOM in the previous 30 days or has concomitant purulent conjunctivitis; amoxicillin/clavulanate is typically used in this case 3.
- Cefdinir or azithromycin should be the first-line antibiotic in those with penicillin allergy based on risk of cephalosporin allergy 3.
- Ibuprofen combined with antibiotics may improve the outcome of experimental pneumococcal AOM, and preserve the animal well-being, avoiding a great weight loss 4.
- Tympanostomy tubes should be considered in children with three or more episodes of AOM within six months or four episodes within one year with one episode in the preceding six months 3, 5.
Management of Acute Otitis Media
- Prophylactic antibiotics are effective in reducing otitis media recurrence, recurrence frequency and total recurrence time 6.
- Tympanostomy tube insertion failed to reduce the prevalence of otitis media recurrence, but reduced the recurrence frequency and total recurrence time 6.
- Adenoidectomy reduced otitis media recurrence; results on otitis media recurrence frequency differed but on average there was a reduction 6.
- A restrictive policy in relation to prescriptions of antibiotics for AOM is supported, and well-informed parents predict a restrictive prescription policy 7.