Acute Otitis Media (AOM)

Haemophilus is an extracellular pathogen, thus macrolides, which concentrate intracellularly, are less effective treatment.

Optimise analgesia and target antibiotics AOM resolves in 60% in 24hrs without antibiotics, which only reduce pain at 2 days (NNT15) and does not prevent deafness.  

Consider 2 or 3-day delayed or immediate antibiotics for pain relief if: 
<2 years AND bilateral AOM (NNT4) or bulging membrane or symptom score above 8 for: fever, tugging ears, crying, irritability, difficulty sleeping, less playful, eating less (0 = no symptoms, 1 = a little, 2 = a lot).

All ages with otorrhoea NNT = 3.  

Antibiotics to prevent mastoiditis NNT >4000

For further information on children see Empiric Antibiotic Therapy poster.

For glossary of terms see Glossary

Drug details

Amoxicillin 
See BNFC for children dosing information

5 days

Penicillin intolerance

Cefuroxime 
See BNFC for Children for dosing information.

5 days

Penicillin Allergy

Clarithromycin
See BNFC for Children for dosing information. 

5 Days

Last reviewed: 14 November 2017

Next review: 14 November 2019

Author(s): Antimicrobial Management Team

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Area Antimicrobial Pharmacist

Document Id: AMT149