5 stages of acute otitis media

The resolution rate of AOM in children is 81% without antibiotic treatment vs. 93% with antibiotic treatment.¹ Thus, antibiotics have limited benefits compared with the potential adverse effects, such as rash, vomiting, or diarrhea.¹⁰

Antibiotic treatment of AOM in children does not decrease early pain (before 24 hours), hearing loss at three months, or recurrence within 30 days.¹⁰

Antibiotic treatment has some beneficial effect on pain after 24 hours (up to 12 days), number of tympanic membrane perforations, and contralateral otitis media.¹⁰ Children younger than two years with bilateral otitis media or otitis media with otorrhea benefit most from antibiotics.¹⁰

If antibiotics are used for AOM, high-dose amoxicillin (80 to 90 mg per kg per day in two divided doses) is first-line therapy, unless the child has taken antibiotics for AOM in the previous 30 days, has purulent conjunctivitis, or has a penicillin allergy.⁷

Observation for 48 to 72 hours with deferment of antibiotics should be considered in lower-risk children with AOM.^7,10

Amoxicillin/clavu

management of acute otitis media in children

management of acute otitis media in children six months of age and older