Acute Otitis Media

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This is an infection of the middle ear, which communicates with the throat. It is important in a febrile child to look for it and treat it. Untreated or poorly managed cases may lead to complications such as mastoiditis, chronic otitis media, deafness, meningitis and brain abscess.

Precursors to the bacteria infections are viral upper respiratory tract infections.

Cause

  • Haemophilus influenzae
  • Haemolytic streptococcus
  • Streptococcus pneumoniae
  • Staphylococcus aureus

Symptoms

  • Fever
  • Sudden and persistent ear ache
  • Purulent discharge from the ear 
  • Vomiting
  • Diarrhoea
  • Crying and agitation
  • Impaired hearing

Signs

  • Red eardrum 
  • Discharging ear
  • Occasionally inflamed throat 
  • Perforated eardrum

Investigations

  • FBC 
  • Ear swab for culture and sensitivity 

TreatmentTreatment Objectives

  • To relieve symptoms
  • To ensure prompt and adequate antibiotic therapy 
  • To prevent chronicity and other complications 

Non-pharmacological treatment

  • Adequate hydration 
  • Surgical repair and drainage of abscess 

Pharmacological treatment 

For pain relief

1st Line Treatment

Evidence Rating: [B]

  • Paracetamol, oral, 

Adults

500 mg-1 g 6-8 hourly

Children

6-12 years; 250-500 mg 6-8 hourly

1-5 years; 120-250 mg 6-8 hourly

3 months-1 year; 60-120 mg 6-8 hourly

For treatment of infection

1st Line Treatment 

Evidence Rating: [B]

  • Amoxicillin, oral,

Adults

500 mg 8 hourly for 10 days 

Children

6-12 years; 250 mg 8 hourly for 10 days

1-5 years; 125 mg 8 hourly for 10 days

< 1 year; 62.5 mg 8hourly for 10 days

Or

  • Amoxicillin + Clavulanic Acid, oral,

Adults

1 g 12 hourly for 7 days

Children

> 12 years; One 500/125 mg tablet 12 hourly for 10  days

6-12 years; 5 ml of 400/57mg suspension 12 hourly for 10 days

1-6 years; 5 ml of 200/28.5 mg suspension 12 hourly for 10 days

1 month-1 year; 2.5 ml of 200/28.5 mg suspension 12 hourly; dose doubled in severe infection

2 weeks-1 month; 1.25 ml of 200/28.5 mg suspension 12 hourly; dose doubled in severe infections

2nd Line Treatment 

Evidence Rating: [B]

  • Cefuroxime, oral,

Adults

250 mg 12 hourly for 5 days 

Children

125 mg 12 hourly for 5 days 

For treatment of infection in patients with penicillin allergy

  • Erythromycin, oral,

Adults

250-500mg 6 hourly for 10 days

Children 

2-8 years; 250 mg 6 hourly for 10 days

1 month-2 years; 125 mg 6 hourly for 10 days

Neonate

12.5 mg/kg 6 hourly

Or

  • Azithromycin, oral,

Adults

500 mg once daily for 5 days

Children

10 mg/kg once daily for 5 days

Referral CriteriaRefer patient to ENT specialist if there is no response after 10 days of treatment