Note: Low grade fever and mild otalgia can frequently persist for up to 48hrs following the initiation of antimicrobiol therapy; If during the treatment, the patient has severe pain, a marked febrile course, or bulging of the tympanic membranes, then change of anti- microbiol therapy is appropriate;
Note: Ampicillin (Amoxicillin) is the single most useful drug in the therapy of Acute Otitis Media;
Antimicrobiol Drugs for Middle Ear Effusion in Children
Drug/10 day course Dose (mg/kg/24hr to Adult Upper Limt)
Amoxicillin 20-40 x 3 divided doses
Ampicillin 50-100 x 4 " "
Erthromycin/Sulfisoxazole 50/150 x 4 " "
Cefaclor 40 x 3 " "
Trimethoprim and Sulfamethoxazole 8 / 40 x 2 " "
Neonatal (<3 month);
-Predisposing conditions include cleft palate, hypotonia, mental retardation;
- Neonate/hospitalized: Same as older infants,
- Enterobacteriaceae (21%), Group B strep.;
- Rx w/ Amoxicillin clavulante or septra or Cefuroxime axetil, or Cefixime; or alternative Cefaclor;
- If parental needed: Cefotaxime or Ampicillin + Gent;
- Note if afebrile, stable & relatively asymptomatic:
- Rx: with Oral regimen;
- If pt. fails to improve in 48 hrs or develops fever, need tympanocentesis, parental therapy; Consider LP for sepsis;
Infants, Children, Adults:
- Consider Pneumococci (28%), H.influenza (21%), B. catarrhalis, Staph aureus (5%), Group A strep (2-5%), "Steril" (10%);
- Rx: <4yrs: erythromycin + sulfonamide;
> 4yrs; Rx: Ampicillin/ /sublactam or septra or Cefuroxime or Cefixime; or alternative: Cefaclor;
- Note Tympanocentesis may hasten resolution and decrease sterile effusion (seen in 70% ofinfants at 14 days after Rx);
Acute w/ Effusion:
Note Endotrach intubation >48hrs; Consider Psuedo sp, Klebsiella, & Enterobacter sp.;
Rx: Ceph III or Ciprofloxacin or Imipenem cilastatin or Ticarcillin clavulanate, or alternative Aztreonam; w/ endotracheal intubation >48hrs about 1/3 pts will have otitis media w/ effusion;
Otitis Media Chronic:
Includes recurrent and prolonged episodes of acute; Etiologies and Rx same as acute; Note; Once a day Amoxicillin or
sulfisoxazole during winter/spring may decrease frequency of recurrent disease; If used, child must be examined every month for effusions;
Tympanostomy tubes may benefit