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Direct treatment of infection
Acute OM traditionally has been treated with antibiotics, either to target a
confirmed bacterial infection or to help avoid one later. According to guidelines
recently published by the American Academy of Pediatrics and the American Academy
of Family Physicians, clinicians treating uncomplicated acute otitis media
are now encouraged to consider the option of managing the pain and fever first,
using only acetominophen or ibuprofen and waiting 48 to 72 hours to see if
the infection begins to clear on its own.1 If the infection persists, then
the first-line antibiotic for the treatment of acute OM should be amoxicillin.
If the patient fails to respond within 48-72 hours, a second-line antibiotic
should be used.1
The AAP/AAFP guidelines recommend the following options for second-line
antibiotic therapy1:
- Amoxicillin/clavulanate
- Cefdinir
- Ceftriaxone
- Cefuroxime
- Azithromycin
- Clarithromycin
The role of underlying allergic inflammation
Allergy often plays a role in otitis media onset, especially when
it recurs or is chronic. The condition is often caused by allergy-related eustachian tube dysfunction, whereby allergy causes inflammation of the tissues lining the eustachian tube. This inflammation hampers fluid drainage, thus trapping bacteria, which leads to infection.2 In fact, as many as 50% of children older than
3 years with chronic otitis media have confirmed allergic rhinitis.3 Once an atopic component is confirmed and allergic rhinitis is
diagnosed, the clinician can treat the associated allergic rhinitis
using a range of options:
- Allergen avoidance
- Antihistamine therapy
- Intranasal corticosteroids
- Intranasal cromolyn sodium
Click here for details on management
options for concomitant allergic rhinitis.
These steps will greatly aid the management of recurrent OM. According
to the American Academy of Allergy, Asthma & Immunology, “When
otitis media is associated with allergic rhinitis, control of allergic
rhinitis frequently results in the resolution of otitis media.”2
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