From the Guidelines
The treatment of otitis media in pediatric patients should begin with pain management using acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours), and antibiotics are recommended for children under 2 years, those with severe symptoms, or bilateral infections, with first-line therapy being amoxicillin at 80-90 mg/kg/day divided twice daily for 10 days in children under 2 years and 5-7 days in older children, as recommended by the American Academy of Pediatrics 1.
Diagnosis and Management
The diagnosis and management of acute otitis media (AOM) in pediatric patients is a critical aspect of pediatric care. The American Academy of Pediatrics (AAP) provides guidelines for the management of AOM, including the use of pneumatic otoscopy for diagnosis and the importance of pain management using analgesics such as acetaminophen or ibuprofen 1.
Antibiotic Therapy
Antibiotic therapy is recommended for children under 2 years, those with severe symptoms, or bilateral infections. First-line antibiotic therapy is amoxicillin at 80-90 mg/kg/day divided twice daily for 10 days in children under 2 years and 5-7 days in older children. For penicillin-allergic patients, alternatives include azithromycin (10 mg/kg on day 1, then 5 mg/kg for 4 days) or clarithromycin (15 mg/kg/day divided twice daily for 10 days) 1.
Treatment Failure
In cases of treatment failure or recurrent infections, amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component) may be used. If the patient is not improved by 48 to 72 hours, another disease or concomitant viral infection may be present, or the causative bacteria may be resistant to the chosen therapy. A change in antibiotic may not be required in some children with mild persistent symptoms, but in children with persistent, severe symptoms of AOM and unimproved otologic findings after initial treatment, the clinician may consider changing the antibiotic 1.
Preventive Measures
Preventive measures include pneumococcal and influenza vaccinations, breastfeeding, avoiding secondhand smoke exposure, and limiting pacifier use in older infants. These measures can help reduce the risk of developing AOM and other respiratory infections.
Otitis Media with Effusion
For otitis media with effusion (OME), a watchful waiting approach for 3 months is often recommended as most cases resolve spontaneously. Tympanometry tubes may be considered for persistent effusions lasting more than 3 months with hearing loss or recurrent AOM (3 episodes in 6 months or 4 in 12 months).
Key points to consider in the management of otitis media in pediatric patients include:
- Pain management using acetaminophen or ibuprofen
- Antibiotic therapy for children under 2 years, those with severe symptoms, or bilateral infections
- First-line antibiotic therapy with amoxicillin
- Alternative antibiotics for penicillin-allergic patients
- Treatment failure and recurrent infections
- Preventive measures to reduce the risk of developing AOM
- Management of otitis media with effusion (OME)
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 recommended treatment for otitis media in pediatric patients is azithromycin with a dose of:
- 30 mg/kg as a single dose
- 10 mg/kg once daily for 3 days
- 10 mg/kg as a single dose on the first day followed by 5 mg/kg/day on Days 2 through 5 2
From the Research
Treatment Options for Acute Otitis Media in Children
- The first-line treatment for acute otitis media (AOM) in children is amoxicillin, with a dosage of 80-90 mg/kg/day 3, 4.
- For patients who fail to respond to amoxicillin, second-line therapy options include high-dose amoxicillin/clavulanate (90 mg/kg/day) and ceftriaxone 3, 5.
- Azithromycin is not recommended as a first-line treatment due to its lower efficacy in eradicating bacterial pathogens, particularly Haemophilus influenzae 6, 7.
- Amoxicillin/clavulanate has been shown to have superior bacteriologic and clinical efficacy compared to azithromycin in children with AOM 6.
Antibiotic Resistance and Treatment Failure
- The increasing prevalence of drug-resistant Streptococcus pneumoniae and beta-lactamase-producing organisms presents a clinical challenge for practitioners in selecting empiric antimicrobial therapy 3, 5.
- Treatment failure and recurrence rates are low for all antibiotic agents, including amoxicillin, amoxicillin/clavulanate, cefdinir, and azithromycin 4.
- Amoxicillin has been shown to have lower treatment failure and recurrence rates compared to other antibiotic agents 4.