Title Acute otitis media.pdf ✅

Version: 11 June 2024 National Antimicrobial Guideline, 4th Edition (2024) Clinical Pathways for Primary Care: Acute Otitis Media Suspected acute otitis media: Otalgia / fever / crying / irritable / URTI symptoms / poor appetite / vomiting / diarrhea (not all symptoms may be present) Otoscopy signs of: middle ear effusion (reduced TM mobility, bulging TM, otorrhea) and middle ear inflammation (erythematous TM, otalgia) TM intact AND non-severe illness (mild otalgia and T <39 oC) Observe for 48-72 hours Give paracetamol for pain relief Resolution Not resolving Not AOM Perforated TM OR severe illness (moderate to severe otalgia or T ≥39 oC or systemically unwell) Other risk factor for severe disease: Immunocompromised, <6months of age, bilateral AOM in less than 2years old, craniofacial abnormalities (e.g.: cleft palate) Refer ENT Red flag: 1. Recurrent acute otitis media 2. Persistent otorrhea 3. Concerns about mastoiditis or other complications of AOM 4. Perceived need for tympanocyntesis and/or myringotomy 5. Abnormal audiological evaluation Resolution No Yes Assess severity / perforation End Start antibiotics Not resolving Start antibiotics Review in 48-72 hours End Recommended dosage (adults) Antibiotics Dosing Duration Remarks Amoxycillin 500mg PO q8h 5-7 days Preferred Amoxycillin / Clavulanate 625mg PO q8h 5-7 days Alternative Erythromycin Ethylsuccinate 400mg PO q6h OR 800mg PO q12h 5-7 days Alternative 1. The WHO AWaRe (Access, Watch, Reserve) antibiotic book 2022. 2. Otitis media (Acute): Antimicrobial prescribing. NICE Guideline March 2022.