Otitis Media, Acute

Description

Medicine Treatment

Referral

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ICD-10 Code: H66.9

DESCRIPTION

• Inflammation of the middle ear of rapid onset.

MEDICINE TREATMENT

In previously untreated patients:

• Amoxicillin, oral, 1000 mg 8 hourly for 5 days. 

LoE:III⁸

Patients not responding to amoxicillin:

• Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 5 days. 

LoE:III⁹

Severe penicillin allergy: (Z88.0)

• Macrolide, e.g.:
  • Azithromycin, oral, 500 mg daily for 3 days.

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. 

LoE:II¹⁰

For management of allergic rhinitis, see Rhinits, allergic, persistent.

For pain:

• Paracetamol, oral, 1 g 4-6 hourly when required.
  • Maximum dose: 15 mg/kg/dose.
  • Maximum daily dose: 4 g in 24 hours.

If pain is not controlled, see chapter: Pain.

LoE:III¹¹

REFERRAL

• No response to amoxicillin/clavulanic acid.
• No pain relief despite treatment.
• Bulging eardrum, not responding to treatment after 24 hours.
• Swelling and pain on palpation of the mastoid process.
• Recurrent otitis media.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition