AOM - healthy child ≥ 6 months old
- In children 6-23 months old with unilateral AOM, or children ≥ 24 months with unilateral or bilateral AOM, consider withholding antibiotics 48-72 hours from symptom onset if symptoms are manageable with systemic analgesics providing adequate follow-up can be assured and no deterioration.
- If symptoms worsen or fail to respond to symptomatic treatment after 48-72 hours, treat with antibiotics.
Usual Pathogens
S. pneumoniae
Moraxella catarrhalis
H. influenzae
Occasionally:
Group A Streptococci
S. aureus
Mild
| Empiric Therapy | Duration | |
|---|---|---|
| Acetaminophen | 10-15mg/dose PO q4h prn (max 75mg/kg/day) |
Reassess at 48 hours |
| or | ||
| Ibuprofen | 10mg/kg/dose PO q6-8h prn (max 40mg/kg/day) |
Reassess at 48 hours |
Moderate-severe
| Empiric Therapy | Duration | |
|---|---|---|
| Amoxicillin (standard dose) | 40mg/kg/d PO div tid | 5 days |
| or | ||
| Amoxicillin (high dose) | 90mg/kg/d PO div bid-tid | 5 days |
If purulent conjunctivitis
| Empiric Therapy | Duration | |
|---|---|---|
|
Amoxicillin-clavulanate (7:1 - Clavulin -200 or -400) |
45mg/kg/d PO div bid | 5 days |
Nonsevere penicillin allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| [Clindamycin | 20-30mg/kg/d PO div tid | 5 days |
| + | ||
| Cefixime] | 8mg/kg/d PO div bid | |
| or | ||
| Cefuroxime axetil | 30mg/kg/d PO div bid | 5 days |
Severe penicillin allergy or cephalosporin allergy AND local S. pneumoniae tetracycline or TMP/SMX resistance < 20%
| Empiric Therapy | Duration | |
|---|---|---|
| Doxycycline (> 8 years old) | 4mg/kg/d PO div bid | 5 days |
| or | ||
| TMP/SMX | 8-12mg TMP /kg/d PO div bid | 5 days |
Severe penicillin allergy or cephalosporin allergy AND local S. pneumoniae tetracycline or TMP/SMX resistance all > 20%
| Empiric Therapy | Duration | |
|---|---|---|
| Levofloxacin | 10-20mg/kg/d PO div q12-24h | 5 days |