How long is medical treatment?

Duration of Treatment for Otitis Media

For acute otitis media (AOM), antibiotic treatment should be administered for 10 days in children under 2 years of age and in those with severe disease, while 5-7 days may be sufficient for children 2 years or older with mild-to-moderate disease. 1

Treatment Duration by Age and Severity

Children Under 2 Years

• Standard duration is 10 days for all cases of AOM in this age group 1, 2, 3
• The longer duration accounts for higher risk of treatment failure and complications in younger children 1
• High-dose amoxicillin (80-90 mg/kg/day) remains first-line therapy 1, 2

Children 2 Years and Older

• 5-7 days of treatment is adequate for uncomplicated, mild-to-moderate AOM 4
• A 5-day course of cefdinir showed comparable efficacy to 10 days of amoxicillin/clavulanate in this population 4
• The shorter duration improves adherence while maintaining clinical effectiveness 4

Severe or Complicated Cases (Any Age)

• 10 days of treatment is recommended regardless of age when disease is severe 1
• Severe disease includes: high fever (≥39°C), moderate-to-severe otalgia, or bilateral AOM in children under 2 years 1

Reassessment Timeline

Initial Follow-up

• Reassess at 48-72 hours if symptoms persist or worsen despite antibiotic therapy 1, 2
• Children failing initial therapy require examination to confirm diagnosis and consider second-line agents 1

Second-Line Treatment

• Switch to amoxicillin/clavulanate or ceftriaxone if high-dose amoxicillin fails after 48-72 hours 1, 2
• Consider drug-resistant Streptococcus pneumoniae or beta-lactamase-producing organisms as the cause of treatment failure 2, 3

Otitis Media with Effusion (OME)

Observation Period

• No antibiotic treatment is indicated for OME, as antibiotics do not hasten clearance of middle ear fluid 1, 5
• Watchful waiting for 3 months is appropriate for uncomplicated OME 1, 3
• Refer to otolaryngology only if effusion persists beyond 3 months with hearing loss, language delay, or anatomic damage 1, 3

Common Pitfalls to Avoid

• Do not extend treatment beyond 10 days for uncomplicated AOM, as this increases antibiotic resistance without improving outcomes 2
• Do not use antibiotics for OME unless acute infection develops, as decongestants and nasal steroids are also ineffective 1
• Do not use prophylactic antibiotics as first-line prevention for recurrent AOM; address modifiable risk factors first 2
• Ensure adequate dosing of amoxicillin (80-90 mg/kg/day) in areas with drug-resistant S. pneumoniae, as traditional dosing is insufficient 1, 2