Initial management of normal child with uncomplicated AOM from 2 mo to 12 yr

Amoxicillin 80-90 mg/kg/day
If received antibiotics in last 30 days start with second-line therapy e.g., amoxicillin 90 mg/kg/day + clavulanic acid 6.4 mg/kg/day, cefuroxime (30 mg/kg/day in 2 divided doses), ceftriaxone (50 mg IM or IV per day for 1 or 3 days)

Age

<6 mo

6 mo-2 yr

>2 yr

End

Amoxicillin 80-90 mg/kg/day alone or with clavulanic acid 6.4 mg/kg/day in 2 divided doses

Observation with follow-up in 48-72 hr
Caregiver must agree, be able to return with child if condition worsens.
System in place to communicate with MD for reevaluation and get medication if needed

Certain diagnosis?

Acute onset signs/symptoms
Signs/symptoms ME inflammation
Presence of MEE
Bilateral to line 3

Yes

No

Is there severe disease?

Moderate or severe otalgia
Fever ≥39° C

Yes

No

Amoxicillin 80-90 mg/kg/day alone or with clavulanic acid 6.4 mg/kg/day in 2 divided doses

Yes

No

Yes or No

Amoxicillin 80-90 mg/kg/day
If received antibiotics in last 30 days start with second-line therapy e.g., amoxicillin 90 mg/kg/day + clavulanic acid 6.4 mg/kg/day, cefuroxime (30 mg/kg/day in 2 divided doses), ceftriaxone (50 mg IM or IV per day for 1 or 3 days)

Observation with follow-up in 48-72 hr
Caregiver must agree, be able to return with child if condition worsens.
System in place to communicate with MD for reevaluation and get medication if needed