Treatment of Acute Otitis Media

Diagnosis

The American Academy of Family Physicians recommends that proper diagnosis of AOM requires a history of acute onset of signs and symptoms, presence of middle ear effusion, signs of middle ear inflammation, and symptoms such as otalgia, irritability, or fever 3

The American Academy of Family Physicians and the American College of Physicians recommend addressing pain immediately with appropriate analgesics regardless of antibiotic decision, with pain management being especially important during the first 24 hours 3, 1

The American Academy of Pediatrics recommends immediate antibiotic therapy for children <2 years with bilateral AOM, children with otorrhea, and patients with severe symptoms, such as moderate to severe otalgia or fever ≥39°C/102.2°F 4, 2
The American Academy of Family Physicians recommends an observation option for 48-72 hours for children ≥2 years with non-severe illness and uncertain diagnosis, limited to otherwise healthy children with mild symptoms 3

The American College of Physicians recommends high-dose amoxicillin (80-90 mg/kg/day) as first-line therapy for children with no penicillin allergy 1
For penicillin allergy, the American College of Physicians recommends non-type I hypersensitivity: cefdinir, cefpodoxime, or cefuroxime, and type I hypersensitivity: azithromycin or clarithromycin 1, 2

The American College of Physicians recommends avoiding macrolides as first-line therapy due to high rates of pneumococcal resistance, and completing the full antibiotic course even if symptoms improve before completion 2, 1
The American Academy of Pediatrics reports that adverse effects of amoxicillin-clavulanate include diarrhea and diaper dermatitis 4

The American College of Physicians recommends reassessing the patient if symptoms worsen or fail to improve within 48-72 hours, with signs of treatment failure including worsening condition, persistence of symptoms beyond 48 hours after starting antibiotics, and recurrence within 4 days of completing treatment 1, 2