Acute Otitis Media (AOM)
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.
1 to 11 months: 125mg TDS
1 to 4 years: 250mg TDS
5 to 17 years: 500mg TDS
Penicillin allergy: Erythromycin
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