Acute otitis media

 Diagnosis: with otoscopy

1. Mild building of tympanic membrane + middle ear effusion + (recent onset ear pain / intense erythema of tympanic membrane)

2.  Moderate to severe bulging of tympanic membrane

3. New onset otorrhea not caused by acute otitis externa

Treatment:

Pain:

Paracetamol 15mg/kg/dose max upto 90mg/kg/day (or) 

Ibuprofen 5-10mg/kg/dose max upto 40mg/kg/day

Decongestants , Antihistamines, Anesthetic ear drops are not recommended.

Antibiotics:

Started in:

1. <6months even with presumed episode of AOM 
2. 6mo - 2yrs with confirmed U/L or B/L AOM
3. > 2yrs with confirmed + severe disease (temp > 102.2°F in past 48hrs, significant otalgia, toxic appearance)

Wait n watch for 2-3 days:

1.  > 2yrs with confirmed but non severe disease
2. 6mo - 2yrs with questionable diagnosis

Choices & Dosages:

1st choice : 

Amoxicillin 50mg/kg/day BD (Mox Redimix)

 <2yrs : given for 10days 

 >2yrs : given for 5-7 days

 

2nd choice:

Amoxicillin(50mkd) + clavulanate(3.2mkd) BD

1. If taken Amoxicillin in past 30 day / has purulent conjunctivitis
2. Treatment failure with Amoxicillin at 48-72hrs

 3rd choice

Ceftriaxone 50mg/kg/day 1-3 days.

                            (Or)

Clindamycin 30mg/kg/day TDS 3 days

1. If treatment failure with amoxiclav at 48-72hrs

 Penicillin sensitivity:

• Cefdinir 14mg/kg/day
• Cefuroxime 30mg/kg/day
• Cefpodoxime 10mg/kg/day
• Ceftriaxone 50mg/kg/day

Cephalosporin sensitivity:

• Azithromycin : D1 - 10mg/kg then 5mg/kg OD * 5 days
• Clarithromycin : 15mg/kg/day BD max 1gm/day
• Clindamycin : 30mg/kg/day TDS max 1.8gm/day

 

Treatment failure even with 3rd choice of drugs warranty tympanocentesis & culture sensitivity.

 Recurrent otitis media:

AOM with in 30 days of treatment.

Look for risk factors - gerd, adenoids, immunodeficiency, cleft palate.

ENT referral.