GuidelinesPEML (Paeds Hospital STG)
Otitis Media, Acute (AOM)
Otitis Media, Acute (AOM)
General and supportive measures
ICD-10 code: H66.9
DESCRIPTION
- Inflammation of the middle ear that may be complicated by perforation and a purulent ear discharge, which usually resolves spontaneously within 14 days. Acute otitis media (AOM) needs to be distinguished from otitis media with effusion (OME), which is NOT treated with antibiotics.
DIAGNOSTIC CRITERIA
- Frequently preceded by a viral upper respiratory tract infection.
- Pain (earache; not due to referred pain), irritability and fever.
- Acute purulent otorrhoea may develop with associated relief of otalgia.
OR at least one of the following:
- Distinct fullness or bulging of the tympanic membrane.
- Marked redness of the tympanic membrane.
| Signs and Symptoms | Otitis Media with Effusion | Acute Otitis Media |
| Impaired hearing | Mild-to-moderate | Mild-to-moderate |
| Pain (otalgia) | No | Mild-to-moderate |
| Tenderness | No | No |
| Purulent drainage (otorrhoea) | No | Only after perforation of tympanic membrane |
| Bacterial infection | No | Yes |
| Systemic symptoms (i.e. fever, malaise) | No | Yes |
GENERAL AND SUPPORTIVE MEASURES
- Avoid getting the inside of the ear wet.
MEDICINE TREATMENT
- Amoxicillin, oral, 45 mg/kg/dose 12 hourly for 10 days.
- Maximum dose: 1.5 g 12 hourly.
Note: For poor response to amoxicillin therapy, or in patients who have received amoxicillin in the last 30 days:
- Amoxicillin/clavulanic acid, oral, 45 mg/kg/dose of amoxicillin component, 12 hourly for 10 days (amoxicillin/clavulanic acid in a ratio of 14:1).
- Maximum dose of amoxicillin component: 1.5 g 12 hourly.
For pain and fever:
See: Pain Control, Management of pain.
REFERRAL
- If symptoms persist despite appropriate antibiotic therapy, the patient shows severe toxicity or there is progression beyond the middle ear, refer to ENT specialist.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 17: Ear Nose & Throat, 17.7 Otitis Media, Acute (AOM)