Acute Otitis Media

Streptococcus pneumoniae 

Haemophilus influenzae 

Moraxella catarrhalis 

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Severe symptoms: moderate or severe otalgia or otalgia > 48 hours, or temperature 39C or higher 

Non-severe symptoms: mild otalgia < 48 hours, temperature <39C 

Recommend initial observation without antibiotic therapy for 48-72 hours in immunocompetent patients with the following criteria: 

6 months-2 years old: unilateral, no otorrhea, non-severe symptoms (see second column) 

OR 

>=2 years old: no otorrhea, non-severe symptoms (see second column) 

Ensure that reassessment and initiation of antibiotic will be feasible if symptoms do not improve during observation 

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For patients not meeting above criteria: 

Amoxicillin  
45 mg/kg/dose (max 1000 mg/dose)* enterally bid  

If patient meets criteria for treatment (same as 3rd column), and has received Amoxicillin within preceding 30 days, has purulent conjunctivitis, history of recurrent AOM not responsive to Amoxicillin, or does not respond to initial therapy with Amoxicillin x 48-72 hours: 

Amoxicillin-clavulanate (Augmentin)
45 mg amoxicillin/kg/dose (max 1000 mg amoxicillin/dose)* enterally bid   

Penicillin allergy with lower risk for allergic reaction: 

Oral cephalosporin (follow link for options) 

Penicillin allergy with higher risk for allergic reaction:  

Consult AAP/AAFP guidelines (linked below) or ASP. Azithromycin is not recommended for this indication. 

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Failed oral therapy:  

Consult AAP/AAFP guidelines (linked below) 

Duration for beta lactam therapy: 

< 2 years old or any age with severe symptoms: 10 days 

2-5 years old: 7 days 

> 5 years old: 5 days 

Pain control recommended for all patients 

*See guidance on Amoxicillin and Amoxicillin-clavulanate maximum dosing and formulation