Acute Otitis Media Treatments

ACUTE OTITIS MEDIA TREATMENTS
Generic	Brand	Strength	Form	Dose	Duration²
FIRST LINE ANTIBIOTIC THERAPY¹
amoxicillin³	—	125mg/5mL, 200mg/5mL, 250mg/5mL, 400mg/5mL	susp	80−90mg/kg/day³ in 2 divided doses every 12hrs	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
amoxicillin/ clavulanate⁴	Augmentin ES⁵	600mg/42.9mg per 5mL	susp	Base dose on amoxicillin component. <3mos: Not established. ≥3mos (<40kg): 90mg/kg/day in 2 divided doses every 12hrs; ≥40kg: not established; use tabs	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
amoxicillin/ clavulanate⁴	Augmentin	875mg/125mg	tabs	Base dose on amoxicillin component. <3mos: Not established. ≥3mos (<40kg): use Augmentin ES susp; (≥40kg): 875mg every 12hrs
ALTERNATIVE ANTIBIOTIC THERAPY⁶
cefdinir	—	125mg/5mL, 250mg/5mL	susp	<6mos: Not recommended. 6mos−12yrs: 7mg/kg every 12hrs or 14mg/kg every 24hrs; max 600mg/day	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
cefuroxime	—	250mg, 500mg	tabs	<13yrs (able to swallow tab): 250mg twice daily	Mild to moderate: <2yrs: 10 days,2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
cefpodoxime	—	50mg/5mL, 100mg/5mL	susp	<2mos: Not recommended. 2mos−12yrs: 5mg/kg (max 200mg) every 12hrs	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
ceftriaxone	—	500mg, 1g	IM inj	50mg/kg (max 1g) IM once	1 day⁷
ANTIBIOTIC FAILURE⁹
amoxicillin/ clavulanate⁴	Augmentin ES⁵	600mg/42.9mg per 5mL	susp	Base dose on amoxicillin component. <3mos: Not established. ≥3mos (<40kg): 90mg/kg/day in 2 divided doses every 12hrs. ≥40kg: not established; use tabs	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
amoxicillin/ clavulanate⁴	Augmentin	875mg/125mg	tabs	Base dose on amoxicillin component. <3mos: Not established. ≥3mos (<40kg): use Augmentin ES susp; (≥40kg): 875mg every 12hrs
ceftriaxone	—	500mg, 1g	IM inj	50mg/kg (max 1g) IM daily	3 days
clindamycin⁶	Cleocin	75mg/5mL	oral soln	30−40mg/kg/day in 3 divided doses with or without 3rd generation cephalosporin¹⁰	Mild to moderate: <2yrs: 10 days, 2−5yrs: 7 days, ≥6yrs: 5−7 days. Severe: 10 days
PAIN MANAGEMENT¹¹
acetaminophen	Children’s Tylenol	160mg/5mL	susp	Give every 4hrs as needed. 6–11lbs: 40mg. 12–17lbs: 80mg. 18–23lbs: 120mg. 24–35lbs: 160mg. 36–47lbs: 240mg. 48–59lbs: 320mg. 60–71lbs: 400mg. 72–95lbs: 480mg. ≥96lbs: 640mg. Max 5 doses/day	As long as needed
ibuprofen	Children’s Motrin	100mg/5mL	susp	<6mos: Not recommended. Give every 6–8hrs as needed. ≥6mos: 12–17lbs: 50mg. 18–23lbs: 75mg. 24–35lbs: 100mg. 36–47lbs: 150mg. 48–59lbs: 200mg. 60–71lbs: 250mg. 72–95lbs: 300mg	As long as needed
NOTES
¹ The American Academy of Pediatrics (AAP) recommends antibiotic therapy for children aged ≥6mos with severe signs and symptoms (eg, moderate to severe otalgia or pain lasting for ≥48hrs, or temp ≥102.2°) and bilateral acute otitis media (AOM) in children aged <24mos without severe symptoms. For unilateral AOM in children aged 6−23mos and bilateral/unilateral AOM in children aged ≥24mos without severe disease, antibiotic therapy or observation with close follow-up based on shared decision-making with the caregiver is recommended (initiate antibiotic therapy if no clinical improvement within 48−72hrs of symptom onset). ² AAP recommends variable duration of therapy depending on age and severity of symptoms. ³ The AOM guideline recommends high dose amoxicillin (off-label) as the first line therapy for children with no penicillin allergy who haven’t received amoxicillin in the past 30 days or absence of concurrent purulent conjunctivitis. ⁴ Consider if previously received amoxicillin in the past 30 days, concurrent purulent conjunctivitis syndrome is present, or history of recurrent AOM unresponsive to amoxicillin. ⁵ Not interchangeable with other formulations of amoxicillin/clavulanate suspension due to the clavulanate component (6.4mg/kg/day; 14:1 ratio). ⁶ Alternative for patients with penicillin allergy. ⁷ The guideline suggests that 3 days of ceftriaxone therapy may be required to prevent recurrence of infection within 5−7 days after the initial dose. ⁸ For intratympanic administration only, in patients with bilateral otitis media with effusion undergoing tympanostomy tube placement. ⁹ Antibiotic therapies after 48−72hrs of failure of initial antibiotic treatment. ¹⁰ Alternative therapy for patients with failure to second antibiotic is clindamycin plus 3rd generation cephalosporin. ¹¹ As per the AOM guideline, analgesics should be given for the management of otalgia, especially for the first 24hrs of presentation, regardless of antibiotic use and should be continued as long as necessary. Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.
REFERENCES
Liberthal AS, Carroll AE, Chonmaitree T, et al. Clinical Practice Guideline: the Diagnosis and Management of Acute Otitis Media. Pediatrics. 2013;131:e964-e999. (Rev. 2/2024)

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