Acute Otitis Media
S. pneumoniae, non-typeable H. influenzae, M. catarrhalis
Amoxicillin 90mg/kg/day PO div q12h (max 1000mg/dose)
If received Amoxicillin w/in prior 30 days:
Amoxicillin-Clavulanate†
90mg/kg/day (amox component) PO div q12h (max 1000mg amox/dose)
Severe or non-severe penicillin allergy:
Cefdinir 14mg/kg/day PO div q12h (max 600mg/dose)
OR
Ceftriaxone 50mg/kg/dose IV/IM q24h (max 1000mg/dose) [1-3 day course pending clinical improvement]
NOTE: Macrolides are not recommended unless severe allergy to penicillin and cephalosporins exist. Resistance is well known and treatment failures related to macrolide resistance have occurred.
Treatment Failure: Consider treatment failure if no improvement after 48-72h of therapy. Consider transition to Amoxicillin-Clavulanate†, Cefdinir, or Ceftriaxone. If failure on second-line therapy, consider ENT referral with tympanocentesis.⁵
Empiric Therapy & Alternative Regimens
Duration of Therapy & Clinical Pearls
AAP AOM Diagnosis and Management
Observation without antibiotics should be considered for: Unilateral AOM in children 6 months to 23 months without severe signs or symptoms (i.e., mild otalgia <48 hours, temperature <39°C), so long as appropriate follow-up can be ensured so that antimicrobial therapy can be started should symptoms worsen or persist beyond 48 to 72 hours.⁵
Length of Therapy:
<2 years of age: 10 days
>2 years of age: 5 days⁶
†Amoxicillin-Clavulanate Dosing
Should use 14:1 Amoxicillin-Clavulanate formulation for Acute Otitis Media.
For additional information regarding amoxicillin-clavulanate dosing and proper formulations, please see Bugs & Drugs Section.