What are the UMHS treatment guidelines for acute otitis media (AOM)?

Updated: Sep 25, 2019
  • Author: John D Donaldson, MD, FRCSC, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The UMHS guidelines concur overall with those of the AAP and include the following additional treatment recommendations [40] :

  • When antibiotic therapy is deferred, facilitate access to antibiotics if symptoms worsen (ie, a "back-up" prescription given at visit)
  • Amoxicillin is the first choice of antibiotic therapy; if amoxicillin is contraindicated, azithromycin is the appropriate first-line therapy
  • For AOM that is unresponsive to amoxicillin after 72 hours of therapy, administer amoxicillin-clavulanate or azithromycin 
  • Patients with significant, persistent symptoms on high-dose amoxicillin-clavulanate or azithromycin may respond to intramuscular ceftriaxone; the decision to use ceftriaxone should weigh the negative impact it will have on local antibiotic resistance

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