AOM Symptom Severity

Treatment Options

• Nonsevere, unilateral AOM in young child (6–23 months)

Nonsevere = mild otalgia <48 hours and fever <39°C (102.2°F) 

• Nonsevere, unilateral or bilateral AOM in older child ( ≥24 months)

Nonsevere = mild otalgia <48 hours and fever <39°C (102.2°F) 

• Treat pain*
• Watchful waiting** is an option to consider based on shared decision making with the patient/family AND follow-up in 48–72 hours

or

• Antibiotic treatment (amoxicillin**) acceptable

• Severe AOM

  Fever ≥39°C (102.2°F) or moderate to severe otalgia or otalgia ≥48 hours

• Bilateral AOM of any severity in young child (6–23 months)
• Otorrhea with AOM

• Treat pain*
• Antibiotic (amoxicillin***) treatment indicated
• Watchful waiting is NOT an option

NOTES:

• *Treatment of pain is the first course of treatment. Offer analgesics (acetaminophen, ibuprofen) for pain relief treatment of otalgia.
• **Watchful waiting criteria is shown in row 1 (green) above. Follow up in 48–72 hours is essential.
• ***Alternate treatment is indicated if penicillin/amoxicillin allergy, recent treatment (<30 days prior), concurrent purulent conjunctivitis, or history of confirmed recurrent AOM unresponsive to amoxicillin. (This does not include otitis media with effusion {OME}) following treatment with amoxicillin for AOM, as this does not denote treatment failure.)

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Lieberthal AS, Carroll AE, Chonmaitree T, et al. AAP Clinical Practice Guideline: The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3);e964-e966