Acute Otitis Media (AOM)

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Patient presents with fever, chills and irritability. Most common under 2 years of age. Examination shows irritable child, tympanic membrane inflamed and bulging.

Natural history

• 60% resolve in 24hrs
• 80% by 48hrs
• 88% 4-7 days
• OME 63% resolve after 2 weeks 40% remaining after one month
• 20% remaining  by 3 months

Organisms that are involved in Acute Otitis Media

Streptococcus pneumonia (35%), Haemophilus influenza (23%), Moraxella catarrhalis (14%) form the majority.

Treatment

• Avoid risk factors-breastfeed for more than 6 months; avoid parental smoking, encourage vaccination, provide good nutrition and encourage early attendance to day care.
• Analgesia and supportive care

Indications for giving antibiotics

• AOM under 6 months
• Severe AOM-temperature (axillary) > 39.5°C
• Associated comorbidity-malnutrition, HIV
• Failure of resolution of symptoms in 48-72 hrs
• Patients who might not return to hospital

First line medicine

Medicine	Adult Dose	Frequency	Duration
amoxicillin po	500mg 40mg/kg in paeds	three times a day	7 days

Caution: Use erythromycin in patients with penicillin allergy, patients who received amoxicillin in the last thirty days (move to second line as the risk of resistance is high)

Second line medicine:

Medicine	Adult Dose	Frequency	Duration
amoxicillin and clavulanic acid po	6.4mg/kg: 80mg/kg	2 times a day	10 days (severe & <6 months) 5-7 days (less severe)

Recurrent Acute Otitis Media

More than four episodes per year - refer