Otitis Media, Acute
Otitis
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ICD-10 Code: H66.9
DESCRIPTION
Inflammation of the middle ear characterised by:
- Pain
- Loss of hearing
- Red bulging eardrum
- Drum perforation
- Fever in about half of the cases
- Loss of the normal light reflex of the eardrums
Mild redness of the eardrum and rubbing the ear are not reliable signs.
GENERAL MEASURES
- Do not instil anything into the ear
- Avoid getting the inside of the ear wet
- Dry mop ear if discharge is present
- Do not plug the ear with cotton wool, etc
- Exclude HIV infection as a contributing factor for recurrent ear infection
MEDICINE TREATMENT
Children
-
Amoxicillin, oral, 45 mg/kg/dose 12 hourly for 5 days.
|
Weight |
Dose |
Use one of the following: |
Age |
|||
|
Syrup |
Capsule |
|||||
|
125 |
250 |
250 |
500 |
|||
|
>3.5–5 kg |
175 mg |
7 mL |
3.5 mL |
- |
- |
>1–3 months |
|
>5–7 kg |
250 mg |
10 mL |
5 mL |
- |
- |
>3–6 months |
|
>7–11 kg |
375 mg |
15 mL |
7.5 mL |
- |
- |
>6–18 months |
|
>11–14 kg |
500 mg |
- |
10 mL |
2 |
1 |
>18 months–3 years |
|
>14–17.5 kg |
750 mg |
- |
15 mL |
3 |
- |
>3–5 years |
|
>17.5–25 kg |
1000 mg |
- |
20 mL* |
4 |
2 |
>5–7 years |
|
>25-30 kg
|
1250 mg
|
-
|
25 mL*
|
5
|
-
|
>7-10 years
|
|
>30 kg
|
1500 mg
|
-
|
-
|
6
|
3
|
>10 years
|
- Review response after 5 days
- If pain or discharge persists, consider alternative diagnosis and continue antibiotics for a further 5 days
Adults
-
Amoxicillin, oral, 1500 mg 12 hourly for 5 days
Antibiotic treatment for those who have taken amoxicillin in the previous 30 days; or poor response to 10-day course of amoxicillin:
Children
- Amoxicillin/ clavulanic acid, oral, 15–25 mg/kg/dose of amoxicillin component, 8 hourly for 5-10 days
|
Weight |
Dose |
Use one of the following: |
Age |
|||
|
Susp |
Susp
250/62.5 mg/5 mL
|
Tablet |
||||
|
>3.5–5 kg |
75 mg |
3 mL |
1.5 mL |
-
|
>1–3 months |
|
|
>5–7 kg |
100 mg |
4 mL |
2 mL |
-
|
>3–6 months |
|
|
>7–9 kg |
150 mg |
6 mL |
3 mL |
- |
>6–12 months |
|
|
>9-11 kg |
200 mg |
8 mL |
4 mL |
- |
>12-18 months |
|
|
>11-14 kg
|
250 mg
|
10 mL
|
5 mL
|
- |
>18 months-3 years
|
|
|
>14-17.5 kg
|
300 mg
|
12 mL
|
6 mL
|
-
|
>3-5 years
|
|
|
>17.5-25 kg
|
375 mg
|
15 mL
|
7.5 mL
|
-
|
> 5-7 years
|
|
|
>25-35 kg
|
500 mg
|
20 mL
|
10 mL
|
1 tablet
|
>7-11 years
|
|
Children >35 kg and adults
- Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 5 to 10 days
Severe penicillin allergy:
ICD-10 Code: Z88.0
Children
- Macrolide, e.g.:
- Azithromycin, oral, 10 mg/kg daily for 3 days. See: dosing table
Children: >35 kg and adults
- Macrolide, e.g.:
- Azithromycin, oral, 500 mg daily for 3 days
Pain:
Children
- Paracetamol, oral, 10–15 mg/kg/dose 6 hourly when required. See: dosing table
Adults
- Paracetamol, oral, 1 g, 4-6 hourly when required
- Maximum dose: 15 mg/kg/dose
- Maximum dose: 4 g in 24 hours
For patients with upper respiratory tract congestion, secondary to allergy: (T78.4)
- Non-sedating antihistamine, oral, e.g.:
- Cetirizine, oral, 10 mg daily for 10 days
For management of allergic rhinitis, see: Allergic Rhinitis
REFERRAL
- Severe pain, fever or vomiting, not responding to treatment after 72 hours (if otoscopy confirmed) or after 24 hours (if otoscopy unconfirmed)
- Recurrent otitis media
- Painful swelling behind the ear or tenderness on percussion of the mastoid
- Suspected meningitis
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2024 Edition