Otitis Media
Regular paracetamol or ibuprofen for pain (right dose for age or weight at the right time and maximum doses for severe pain).
Otorrhoea or under 2 years with infection in both ears: Consider no, back-up or immediate antibiotic.
Otherwise: No or back-up antibiotic.
Systemically very unwell or high risk of complications: Immediate antibiotic.
Second choice: If worsening symptoms on first choice taken for at least 2 to 3 days.
Preferred
First Choice: amoxicillin po (see dosing table). Alternatively dosing of 40mg/kg (Max 1g) po BD may be used*
-
Treat for 5 days.
|
Age |
Amoxicillin oral dose |
|
1 month to 11 months |
125mg TDS |
|
1 year - 4 years |
250mg TDS |
|
5 years and over |
500mg TDS |
*Off-license dosing. Reference: World Health Organisation. Recommendations for management of common childhood 2012 conditions. WHO link accessed 02/23
Second choice: worsening symptoms on first choice taken for at least 2 to 3 days:
co-amoxiclav po (see dosing table)
| Age | co-amoxiclav oral dose |
|
1 month to 11 months |
0.5mL/kg of 125mg/31mg/5mL suspension TDS |
| 1 year to 5 years |
10mLs of 125mg/31mg/5mL suspension TDS |
| 6 years to 11 years |
10mLs of 250mg/62mg/5mL suspension TDS |
| 12 years to 17 years | One 625mg tablet TDS OR 10mLs of 250mg/62mg/5mL suspension TDS if patient cannot take tablets |
Alternative
For penicillin allergy
Under 6 months: clarithromycin po, see dosing table, for 5 days
| Weight | clarithromycin oral dose |
| Under 8kg | 7.5mg/kg BD |
| 8-11kg | 62.5mg BD |
| 12-19 kg | 125mg BD |
6 months and over: azithromycin 10mg/kg (Max 500mg) po OD for 3 days.
Second choice: worsening symptoms on first choice taken for at least 2 to 3 days: Consult Paediatric ID.