Guidelines for the Diagnosis and Treatment of Acute Otitis Media | ||
| ILLNESS SEVERITY | DIAGNOSTIC CRITERIA | TREATMENT RECOMMENDATIONS |
|---|---|---|
| Mild to moderate | >2 yrs or 6 mo to 2 yrs without middle-ear effusion | Observation alone (deferring antibiotic therapy for 48-72 h and limiting management to symptom relief) |
<6 mo; or 6 mo to 2 yrs with middle-ear effusion (fluid in the middle ear, evidenced by decreased TM mobility, air/fluid level behind TM, bulging TM, purulent otorrhea) and acute onset of signs and symptoms of middle-ear inflammation, including fever, otalgia, decreased hearing, tinnitus, vertigo, erythematous TM; or >2 yrs with bilateral disease, TM perforation, high fever, immunocompromise, emesis | Initial therapya : Amoxicillin, 80-90 mg/kg qd (up to 2 g) PO in divided doses (bid or tid); or Cefdinir, 14 mg/kg qd PO in 1 dose or divided doses (bid); or Cefuroxime, 30 mg/kg qd PO in divided doses (bid); or Azithromycin, 10 mg/kg qd PO on day 1 followed by 5 mg/kg qd PO for 4 d Exposure to antibiotics within 30 d or recent treatment failurea,b : Amoxicillin, 90 mg/kg qd (up to 2 g) PO in divided doses (bid), plus clavulanate, 6.4 mg/kg qd PO in divided doses (bid); or Ceftriaxone, 50 mg/kg IV/IM qd for 3 d; or Clindamycin, 30-40 mg/kg qd PO in divided doses (tid) | |
| Severe | As above, with temperature ≥39.0°C (≥102°F); or Moderate to severe otalgia | Initial therapya : Amoxicillin, 90 mg/kg qd (up to 2 g) PO in divided doses (bid), plus clavulanate, 6.4 mg/kg qd PO in divided doses (bid); or Ceftriaxone, 50 mg/kg IV/IM qd for 3 d Exposure to antibiotics within 30 d or recent treatment failurea,b : Ceftriaxone, 50 mg/kg IV/IM qd for 3 d; or Clindamycin, 30-40 mg/kg qd PO in divided doses (tid); or Consider tympanocentesis with culture |
a Duration (unless otherwise specified): 10 days for pts <6 years old and pts with severe disease; 5-7 days (with consideration of observation only in previously healthy individuals with mild disease) for pts ≥6 years old.
b Failure to improve and/or clinical worsening after 48-72 h of observation or treatment.
Abbreviation: TM, tympanic membrane.
Source: Data from American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media, 2004.