Research Article| Volume 22, ISSUE 1, P29-39, January 2000

Antimicrobial therapy of acute otitis media: review of treatment recommendations

      This paper is only available as a PDF. To read, Please Download here.


      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.


      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.


      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Aronovitz GH
        • Doyle CA
        • Durham SJ
        • et al.
        Cefprozil vs amoxicillin/clavulanate in the treatment of acute otitis media.
        Infect Med. 1992; 9: 19-32
        • Hoppe HL
        • Johnson CE
        Otitis media: Focus on antimicrobial resistance and new treatment options.
        Am J Health Syst Pharm. 1998; 55: 1881-1897
        • Etzil RA
        • Pattishall EN
        • Haley NJ
        • et al.
        Passive smoking and middle ear effusion among children in day care.
        Pediatrics. 1992; 90: 228-232
        • Berman S
        Otitis media in children.
        N Engl J Med. 1995; 332: 1560-1565
        • Yawn BP
        • Yawn RA
        • Lydick E
        The relative community burden of otitis media and varicella.
        Clin Ther. 1996; 18: 877-886
        • Bluestone CD
        Otitis media: To treat or not to treat?.
        Consultant. 1998; 38: 1421-1433
        • Rosenfeld JA
        Managing middle ear inflammation: A review.
        Fam Pract Recertification. 1990; 24: 45-51
        • Agency for Health Care Policy and Research
        Otitis media with effusion in young children. Guideline overview.
        J Natl Med Assoc. 1994; 86: 731-732
        • Agency for Health Care Policy and Research
        Otitis media with effusion in young children. Guideline overview.
        J Natl Med Assoc. 1994; 86: 792-793
        • Magit AE
        • Stool SE
        Clinical guideline development for otitis media: Report on methodology.
        Otolaryngol Head Neck Surg. 1993; 109: 478-481
        • Harrison CJ
        Rational selection of antimicrobials for pediatric upper respiratory infections.
        Pediatr Infect Dis J. 1995; 14: S121-S129
        • McCracken Jr., GH
        Treatment of acute otitis media in an era of increasing microbial resistance.
        Pediatr Infect Dis J. 1998; 17: 576-579
        • Dowell SF
        • Butler JC
        • Giebink GS
        • et al.
        Acute otitis media: Management and surveillance in an era of pneumococcal resistance—A report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group.
        Pediatr Infect Dis J. 1999; 18: 1-9
        • Cohen R
        • Navel M
        • Grunberg J
        • et al.
        One dose of ceftriaxone vs ten days of amoxicillin/clavulanate therapy for acute otitis media: Clinical efficacy and change in nasopharyngeal flora.
        Pediatr Infect Dis J. 1999; 18: 403-409
        • Kalish GH
        Satisfaction with outcome as a function of patient expectation: The national antibiotic patient satisfaction surveys.
        Health Care Innov. 1996; 6: 9-12
        • Kalish GH
        Satisfaction with outcome as a function of patient expectation: The national antibiotic patient satisfaction surveys.
        Health Care Innov. 1996; 6: 29-33
        • Davidson RJ
        • Canadian Bacterial Surveillance Network
        • Low DE
        A cross-Canada surveillance of antimicrobial resistance in respiratory tract pathogens.
        Can Infect Dis. 1999; 10: 126-133
        • Fung-Tomc JC
        • Huczko E
        • Stickle T
        • et al.
        Antibacterial activities of cefprozil compared with those of 13 oral cephems and 3 macrolides.
        Antimicrob Agents Chemother. 1995; 39: 533-538
        • Thornsberry C
        • Brown SD
        • Yee C
        • et al.
        Increasing penicillin resistance in Streptococcus pneumoniae in the US: Effect on susceptibility to oral cephalosporins.
        Infect Med. 1993; 10: 15-24
        • Shyu WC
        • Haddad J
        • Khan WN
        • et al.
        Penetration of cefprozil into middle ear fluid of patients with otitis media.
        Antimicrob Agents Chemother. 1994; 38: 2210-2212
        • Arguedas AG
        • Aaleska M
        • Stutman HR
        • et al.
        Comparative trial of cefprozil vs. amoxicillin clavulanate potassium in the treatment of children with acute otitis media with effusion.
        Pediatr Infect Dis J. 1991; 10: 375-380
        • Pichichero ME
        • McLinn S
        • Aronovitz G
        • et al.
        Cefprozil treatment of persistent and recurrent acute otitis media.
        Pediatr Infect Dis J. 1997; 16: 471-478
        • Asmar BI
        • Dajani AS
        • Del Beccaro MA
        • et al.
        Comparison of cefpodoxime proxetil and cefixime in the treatment of acute otitis media in infants and children.
        Pediatrics. 1994; 94: 847-852
        • Fernández MacLoughlin GJ
        • Gomez Barrelo D
        • de la Torre C
        • et al.
        Cefpodoxime proxetil suspension compared to cefaclor suspension for treatment of acute otitis media in paediatric patients.
        J Antimicrob Chemother. 1996; 37: 565-573
        • Nelson CT
        • Masòn EO
        • Kaplan SL
        Activity of oral antibiotics in middle ear and sinus infections caused by penicillin-resistant Streptococcus pneumoniae: Implications for treatment.
        Pediatr Infect Dis J. 1994; 13: 585-589
        • Poole JM
        • Rosenberg R
        • Aronovitz GH
        • et al.
        Cefprozil vs cefixime and cefaclor in otitis media in children.
        Infect Med. 1992; 9: 21-32
        • Rosenfeld RM
        • Vertrees JE
        • Carr J
        • et al.
        Clinical efficacy of antimicrobial drugs for acute otitis media: Meta-analysis of 5400 children from thirty-three randomized trials.
        J Pediatr. 1994; 124: 355-367
        • Klein JO
        Clinical implications of antibiotic resistance for management of acute otitis media.
        Pediatr Infect Dis J. 1998; 17: 1084-1089
        • Canafax DM
        • Yuan Z
        • Chonmaitree T
        • et al.
        Amoxicillin middle ear fluid penetration and pharmacokinetics in children with acute otitis media.
        Pediatr Infect Dis J. 1998; 17: 149-156