Acute otitis media

Case Definition:

An acute infection of the middle ear, common in young children between 6 months and 2 years of age. Usually occurs as part of an upper respiratory tract infection, with Haemophilus influenza and Pneumococcus being the most common pathogens. Recurrent acute otitis media may lead to chronic suppurative otitis media (cholesteatoma); surgical intervention is usually the treatment of choice.

 

Diagnostic criteria:

Presents as severe otalgia and deafness. The tympanic membrane is red and bulging, perforation can occur leading to purulent otorrhoea. Often the otalgia settles when perforation occurs.

 

Specimens to be collected:

  • Ear swab if pus discharging

 

Notes

NICE guidance on URTI indicates that antibiotics are not routinely indicated for category A patients with acute otitis media. Analgesia should be optimised. 60% of patients, including children, improve within 24 hours without antibiotics and antibiotics only reduce pain at 2 days and do not prevent deafness.

Antibiotic treatment should be considered in those patients who are under 2 years old with bilateral acute otitis media, and those of any age with otorrhoea.

 

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)
A

Minor to moderate infection

Review doses in renal impairment

Antibiotics not routinely indicatied (see above)

AMOXICILLIN 500mg po tds

Typical total duration: 5 days

Antibiotics not routinely indicatied (see above)

CLARITHROMYCIN 500mg po bd

Typical total duration: 5 days

B/C

Moderate to severe life threatening infection 

Review doses in renal impairment

Typical total duration: 5 days

CO-AMOXICLAV 1.2g iv tds

Typical total duration: 5 days

 
 

CLARITHROMYCIN 500mg po/iv bd

Typical total duration: 5 days

 

 

IV to Oral Switch (explanatory notes

CO-AMOXICLAV 625mg tds

Typical total duration: 5 days

CLARITHROMYCIN 500mg po bd

Typical total duration: 5 days

 Last reviewed 23/04/14

 For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)