Acute Otitis Media (AOM)

Further clinical guidance including interpretation of microbiology results available from:

CKS - acute Otitis Media scenarios guidance

NICE feverish children

Optimise analgesia and target antibiotics 

AOM resolves in 60% in 24hrs without antibiotics, which only reduce pain at 2 days (NNT15) and does not prevent deafness.

Consider 2 or 3-day delayed or immediate antibiotics for pain relief if:

<2 years AND bilateral AOM (NNT4) or bulging membrane or symptom score >8 for: fever; tugging ears; crying; irritability; difficulty sleeping; less playful; eating less (0 = no symptoms, 1 = a little, 2 = a lot)

All ages with otorrhoea NNT3.

Abx to prevent Mastoiditis NNT >4000.


500mg TDS



1 to 11 months: 125mg TDS

1 to 4 years: 250mg TDS

5 to 17 years: 500mg TDS

5 days

Penicillin allergy: Erythromycin

250mg-500mg QDS



1 month to 23months: 125mg QDS or 250mg BD

2 to 7 years: 250mg QDS or 500mg BD

8 to 17 years: 250mg to 500mg QDS or 500mg to 1000mg BD

5 Days