Otitis media, acute

H66.9

DESCRIPTION

Inflammation of the middle ear characterised by:

  • pain
  • drum perforation
  • loss of hearing
  • fever in about half of the cases
  • red bulging eardrum
  • loss of the normal light reflex of the eardrum

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.

Ottis Media Acute Medicine Treatment.png
  • LoIII [6]
    • Review response after 5 days.
    • If pain or discharge persists, consider alternative diagnosis and continue antibiotics for a further 5 days.

LoEIII [7]

Adults

  • Amoxicillin, oral, 1500 mg 12 hourly for 5 days.

LoEIII [8]

Antibiotic treatment for those who have taken amoxicillin in the previous 30 day; 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.

Ottis Media Acute_Amoxicillin.png

LoEIII [9]

Children > 35 kg and adults

  • Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 5 to 10 days.

LoEIII [10]

Severe Penicillin allergy: (Z88.0)

Children

  • Macrolide, e.g.:
  • Azithromycin, oral, 10 mg/kg/dose, daily for 3 days. See paediatric dosing tool.

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 paediatric dosing tool.

LoEII [11]

Adults

  • Paracetamol, oral, 1 g 4–6 hourly when required to a maximum of 4 doses per 24 hours.
    • 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.

[LoE:II]10

For management of allergic rhinitis, see section 19.1: 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.