Treatment is focused at eliminating microbes from the middle
ear space. It is generally believed approximately two-thirds of
all cases of AOM are secondary to bacterial pathogens. A breakdown
of the most common AOM pathogens is shown below:
Organism |
% of AOM |
Considerations |
|
S. pneumoniae |
40-50 |
Majority of serotypes contained within pneumococcal vaccine |
|
H. influenza |
20 |
Uually nontypable strains
|
|
M. catarrhalis |
7 |
Usually beta-lactamase producing |
Infants under one month of age presenting with AOM should be
referred for further evaluation. Strong consideration should be
given for hospitalization and septic evaluation of these infants.
Older infants and children are generally treated with antibiotics
and analgesics as indicated. Antibiotics remain the cornerstone
of treatment of acute otitis media in the United States.
Treatment recommendations do exist which allow the clinician to
follow common sense principles in antimicrobial administration.
Principles
of Judicious Use of Antimicrobial Agents for the Pediatric Upper
Respiratory Tract Illnesses outlines six ìprinciplesî
for rational treatment of AOM (click here for the electronic
abstract). These guidelines recommend:
The majority of references recommend amoxicillin (40 mg/kg/d) as the drug of choice for initial treatment of uncomplicated AOM. Recent Center for Disease Control (CDC) recommendations include ìhigh doseî amoxicillin therapy (80-90 mg/kg/day in three divided doses) for children that have received antibiotics in the month prior to treatment, attend day care, or live in an area with a high prevalence of drug-resistant pneumococci. See Dowell, S.F. or Chartrand and Pong for more information on "high dose amoxicillin" and drug resistant pneumococci. However, initial antibiotic selection should take into account several considerations, including:
Common alternatives to amoxicillin include trimethoprim-sulfa, erythromycin-sulfa, or one of the second or third generation cephalosporins. Antibiotics indicated for amoxicillin failures include amoxicillin/clavulanate, cefuroxime, or ceftriaxone. As noted above, tympanocentesis is indicated in the neonate with AOM or persistent acute otitis media despite adequate antibiotic therapy. Click here for Edenís reference on management of otitis media. Se lect one of the following for more information on the commonly prescribed antibiotics used to treat AOM: