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Abstract
Objective
This paper reviews 3 previously published articles that provided recommendations for
antimicrobial therapy of acute otitis media (AOM) and combines them to provide revised
recommendations.
Background
AOM is one of the most common pediatric infections requiring a prescription for an
antimicrobial agent. The optimal approach to treatment of AOM requires early, efficacious,
and practical therapy. Several experts and organizations have developed recommendations
for the management of AOM, but the number of these may overwhelm the busy primary
care practitioner. A MEDLINE® search of the pediatric and infectious disease literature on AOM treatment recommendations
was used to select 3 representative, previously published articles for this review.
When selecting an agent, physicians should consider in vitro activity, particularly
against drug-resistant Streptococcus pneumoniae; pharmacokinetics; adverse events; palatability of the suspension; and cost. In addition,
physicians' clinical experience is an important determinant.
Conclusions
Amoxicillin is recommended as the first-line agent to treat uncomplicated AOM. For
clinical treatment failures after 3 days of amoxicillin, recommended antimicrobial
agents include oral amoxicillin/clavulanate, cefuroxime axetil, cefprozil, cefpodoxime
proxetil, and intramuscular (IM) ceftriaxone. IM ceftriaxone should be reserved for
severe cases or patients in whom noncompliance is expected. Tympanocentesis for identification
of pathogens and susceptibility to antimicrobial agents is recommended for selection
of third-line agents.
Key words
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Article info
Publication history
Accepted:
December 16,
1999
Identification
Copyright
© 2000 Published by Elsevier Inc.
