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

From the Guidelines

The treatment for otitis media in children typically involves antibiotics, pain management, and watchful waiting depending on the child's age and symptom severity, with amoxicillin being the first-line antibiotic for children under 2 years or those with severe symptoms, as recommended by the American Academy of Pediatrics and American Academy of Family Physicians 1. The diagnosis and management of acute otitis media (AOM) in children is a complex process that requires careful consideration of the child's age, symptom severity, and medical history.

• For children under 2 years or those with severe symptoms, amoxicillin is the first-line antibiotic, usually prescribed at 80-90 mg/kg/day divided into two doses for 10 days 1.
• For children allergic to penicillin, alternatives include azithromycin (10 mg/kg on day 1, then 5 mg/kg for 4 days) or cefdinir (14 mg/kg/day divided twice daily for 10 days) 1.
• Pain management is essential using acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours) 1.
• For children over 2 years with mild symptoms, a watchful waiting approach for 48-72 hours may be appropriate before starting antibiotics 1. The American Academy of Pediatrics and American Academy of Family Physicians recommend a stringent definition of AOM and provide guidelines for the diagnosis and initial treatment of AOM, including pain management, initial observation versus antibiotic treatment, and preventive measures 1.
• Recurrent infections may require evaluation for ear tubes (tympanostomy tubes) 1.
• Antibiotics are effective because they target the common bacterial causes of otitis media, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, which typically infect the middle ear when Eustachian tube function is compromised 1.

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 for Otitis Media in children is azithromycin given at 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 for Otitis Media in Children

The treatment for otitis media in children typically involves a combination of pain management and antibiotic therapy.

• Pain management is a crucial aspect of treating otitis media, with paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) being commonly used to relieve ear pain and reduce fever 3, 4.
• Antibiotic therapy is usually reserved for cases where the infection is suspected to be bacterial in origin, and the child is at high risk of complications or has a severe infection 5, 6.
• The choice of antibiotic depends on various factors, including the severity of the infection, the child's age, and the presence of any underlying medical conditions 5, 6.
• Amoxicillin is often the first-line antibiotic used to treat otitis media in children, with amoxicillin-clavulanic acid being used in cases where there is a high risk of infection by β-lactamase-producing bacteria 5, 6.
• Other antibiotics, such as azithromycin, cefprozil, and clarithromycin, may also be used in certain cases, although their effectiveness may vary depending on the specific circumstances 7.

Pain Management

Pain management is an essential aspect of treating otitis media in children, with the goal of relieving ear pain and reducing fever.

• Paracetamol (acetaminophen) and NSAIDs, such as ibuprofen, are commonly used to manage pain and reduce fever in children with otitis media 3, 4.
• The effectiveness of paracetamol and NSAIDs in relieving pain and reducing fever in children with otitis media has been demonstrated in several studies 3, 4.
• However, the evidence is limited, and further research is needed to determine the optimal pain management strategy for children with otitis media 3, 4.

Antibiotic Therapy

Antibiotic therapy is usually reserved for cases where the infection is suspected to be bacterial in origin, and the child is at high risk of complications or has a severe infection.

• The choice of antibiotic depends on various factors, including the severity of the infection, the child's age, and the presence of any underlying medical conditions 5, 6.
• Amoxicillin is often the first-line antibiotic used to treat otitis media in children, with amoxicillin-clavulanic acid being used in cases where there is a high risk of infection by β-lactamase-producing bacteria 5, 6.
• Other antibiotics, such as azithromycin, cefprozil, and clarithromycin, may also be used in certain cases, although their effectiveness may vary depending on the specific circumstances 7.