What is the treatment for Acute Otitis Media (AOM)?

From the Guidelines

The first-line treatment for acute otitis media (AOM) is amoxicillin, dosed at 80-90 mg/kg/day, due to its effectiveness, safety, and narrow microbiologic spectrum 1. When treating AOM, it is essential to consider the anticipated clinical response and the microbiologic flora likely to be present.

• Amoxicillin is recommended as the first-line therapy for AOM because it is generally effective against susceptible and intermediate resistant pneumococci 1.
• The optimal duration of therapy for patients with AOM is uncertain, but clinical improvement should be noted within 48-72 hours 1.
• If the patient is allergic to amoxicillin and the allergic reaction is not a type I hypersensitivity reaction, alternatives such as cefdinir, cefpodoxime, or cefuroxime can be considered 1.
• Pain management with acetaminophen or ibuprofen is also crucial in the treatment of AOM.
• If symptoms worsen or do not improve within 48-72 hours, reevaluation is necessary to consider alternative antibiotics or rule out complications 1.
• In cases where the patient has received antibiotics in the past 30 days or has concurrent conjunctivitis, amoxicillin-clavulanate may be preferred 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.

AOM Treatment:

• Amoxicillin-clavulanate (PO) is effective in treating Acute Otitis Media (AOM) in pediatric patients, with cure rates of 87% at the end of therapy and 67% at follow-up for the every 12 hours regimen, and 82% at the end of therapy and 69% at follow-up for the every 8 hours regimen 2.
• Azithromycin (PO) is also effective in treating AOM in pediatric patients, with clinical success rates of 88% at Day 11 and 73% at Day 30 3.
• The choice of treatment should be based on the specific clinical situation and patient characteristics.

From the Research

AOM Treatment Overview

• The primary goals of treating acute otitis media (AOM) are to relieve pain, control fever, and overcome bacterial infection in cases of suppurative AOM 4.
• Treatment options include:
  • Salicylates or paracetamol for pain and fever management
  • Antibiotics for bacterial infections, with amoxicillin being the first-line treatment 4, 5, 6
  • Local instillation of anaesthetic-antiseptic solutions for painful congestive viral otitis 4

Antibiotic Treatment

• Amoxicillin is the recommended first-line antibiotic for AOM, with a duration of 8-10 days depending on the presence of spontaneous perforation 4, 5, 6.
• For patients who have failed amoxicillin treatment, second-line options include:
  • High-dose amoxicillin/clavulanate 5, 6
  • Ceftriaxone 5, 6
  • Cefuroxime axetil, cefprozil, and cefpodoxime proxetil 6
• The choice of antibiotic should consider factors such as in vitro activity, pharmacokinetics, adverse events, and cost 6.

Specific Patient Populations

• Children who attend childcare or have recently received an antibiotic may require treatment with high-dose amoxicillin 7.
• Infants under 6 months of age and children with repeated AOM may require closer monitoring and alternative treatment options 4, 5.

Alternative Treatment Options

• Clarithromycin has been shown to be a safe and effective alternative to amoxicillin-clavulanate for the treatment of AOM in children 8.
• Tympanocentesis may be useful for identifying the causative pathogen and guiding antibiotic treatment in cases of treatment failure or recurrent AOM 5, 6.