Otitis Media [2013 update]
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Key and newer aspects of care that are elaborated in the guideline include:
- The diagnosis of acute otitis media (AOM) should be based on symptoms of fever and/or otalgia in conjunction with the identification of an inflammatory middle ear effusion.
- Deferring antibiotic therapy should be considered for children age 2 and older with AOM and mild to moderate symptoms.
- Analgesic therapy should be recommended for all children with AOM.
- When antibiotic therapy is deferred, facilitate patient access to antibiotics if symptoms worsen (e.g., a "back-up" prescription given at visit or a convenient system for subsequent call-in).
- For children with AOM unresponsive to high dose amoxicillin, either amoxicillin/clavulanate or high dose azithromycin are appropriate second line therapies.
- Oral cephalosporins should not be used to treat AOM.
- Referral to otolaryngology for otitis media with effusion (OME) should be based on apparent developmental or behavioral problems or concern for anatomic damage to middle ear structures, rather the simple duration of the effusion.
When medical antibiotic treatment is indicated:
- High dose amoxicillin is the first choice of antibiotic therapy for all cases of AOM.
- Dosing: < 4 years, 80 mg/kg/day divided BID; ≥ 4 years, 40- 60 mg/kg/day.
- Duration 5- 10 days: 5 days is usually sufficient at lower cost and fewer side effects, although 10 days reduces clinical failure [A*]. Consider 10-day course for young children with significant early URI symptoms, children with possible sinusitis, and children with possible strep throat.
- Adults: either 875 mg BID x 10 days or 500 mg 2 tabs BID x 10 days.
- amoxicillin/clavulanate – pediatric 80 mg/kg divided BID x 10 days; adult 875/125 mg BID x 10 days
- azithromycin – pediatric 20 mg/kg daily for 3 days; adult 1 g daily for 3 days
The University of Michigan Medical School designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Release Date: April 2013
Termination Date: February 2022
Continued availability of CME credit for this activity depends on a thorough review of its content every three years. This activity was last reviewed for currency and accuracy in February 2019, and availability of CME credit continued.
Heather L. Burrows, MD, PhD; General Pediatrics
R. Alexander Blackwood, MD; Pediatric Infectious Disease
James M. Cooke, MD; Family Medicine
R. Van Harrison, PhD; Medical Education
Kathryn M. Harmes, MD; Family Medicine
Peter P. Passamani, MD; Pediatric Otolaryngology
Kristin C. Klein, PharmD; UMH Pharmacy Services
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