Otitis media (acute suppurative) and mastoiditis
Antimicrobials are not indicated for early disease.
Mild disease
Symptoms not improving for more than 48 hours.
topical ciprofloxacin 0.3% ear drops (if tympanic perforation is present)
AND EITHER
amoxicillin 500mg po tds OR doxycycline 100mg po bd
Complicated acute otitis media
Rarely acute otitis media can spread to involve other structures including the inner ear (suppurative labyrinthitis), mastoid and periosteum. Further dissemination can include sepsis and brain abscess.
Acute otitis media involving the inner ear (suppurative labyrinthitis), can result in the clinical syndrome of otitis media with vertigo. Prompt antibiotic therapy is appropriate for complicated cases to prevent further spread of infection to the CNS.
Refer complicated cases urgently to ENT and urgent imaging is indicated.
Severe infection with labyrinthitits/ mastoiditis / subperiosteal mastoid abscess AND/OR evidence of systemic sepsis
Typically treat for between 5-10 days according to severity and clinical response
Preferred
amoxicillin 1g po tds (or iv in NBM)
If no improvement or worsening after 2 days: change to co-amoxiclav 625mg po tds (or 1.2g iv tds if NBM)
Oral follow on treatment: as for mild disease above
Alternative
For penicillin allergy (non-severe or severe) or MRSA positive
doxycyline 100mg po bd OR co-trimoxazole 960mg po bd (iv if NBM)