Acute Otitis Media

Observation is an appropriate option only when follow-up can be ensured and
antibacterial agents started if symptoms persist or worsen. Nonsevere illness is
mild otalgia and fever <39°C in the past 24 hours. Severe illness is moderate to
severe otalgia or fever 39°C. A certain diagnosis of AOM meets all 3 criteria:
1) rapid onset, 2) signs of Middle ear effusion, and 3) signs and symptoms of
middle-ear inflammation.

Antimicrobial Therapy

- Amoxicillin should be started at a dose of 80 to 90 mg/kg per day
- Alternatives in patients with a history of a non-type I allergic reaction to
penicillins are cefpodoxime, or cefuroxime.
- In cases of type I reactions, alternatives are azithromycin, clarithromycin,
erythromycin-sulfisoxazole, or sulfamethoxazole-trimethoprim.
- Ceftriaxone (50 mg/kg per day), given for 3 consecutive days either
intravenously or intramuscularly, can be used in children with vomiting or in
other situations that preclude administration of oral antibacterial agents.
- In the treatment of AOM unresponsive to initial antibacterial therapy, a 3-day
course of ceftriaxone has been shown to be better than a 1-day regimen.