Acute otitis media

Once vital signs have been checked and sepsis excluded, for a child presenting with symptoms suggestive of  acute otitis media:

• Painful ear
• History of fever
• Ear discharge

Consider the following management for pain and fever:

• Regular paracetamol or ibuprofen
• Ensure sufficient fluid intake and urine output

Review patient if there is significant worsening at any time.

Typical duration of symptoms is 4 days but 20% of children have symptoms lasting more than one week.

Antibiotics are not indicated in the majority of children presenting with acute otitis media:

• NNT = 33 for reducing tympanic perforation and 11 for reducing acute otitis media in unaffected ear
• NNH = 14 for adverse event due to antibiotics

However in children < 2 years with bilateral acute otitis media consider:

• First line – Amoxicillin for 5 days (see cBNF)
• Second line – Erythromycin for 5 days (see cBNF)