Acute Otitis Media Protocol

Primary care diagnostic filter, severity screening, and antimicrobial pathways.

1. Diagnostic & Otoscopy Filter

AOM requires a combination of clinical symptoms and matching structural signs.

Otoscopy Diagnostic Criteria (Both Required):

Middle Ear Effusion: Reduced TM mobility, bulging TM, or active otorrhea.
Middle Ear Inflammation: Erythematous TM or distinct otalgia.

🟢 Non-Severe (Intact TM)

Mild otalgia and Temperature < 39°C.

Management Strategy:

Observe for 48 – 72 hours.
Prescribe paracetamol for initial symptomatic pain relief.
Start antibiotics only if condition is not resolving at review.

🔴 Severe OR Perforated TM

Moderate to severe otalgia, Temp ≥ 39°C, or systemically unwell.

Management Strategy:

Start empirical antibiotics immediately.
Review clinical status in 48 – 72 hours.
Refer out to ENT if not resolving at review.

🚨 Clinical Red Flags & High Risk Markers

Any of the following criteria warrants close monitoring or direct specialist escalation.

Other Risk Factors for Severe Disease:

Immunocompromised states, <6months of age, bilateral AOM in less than 2years old, craniofacial abnormalities (e.g., cleft palate).

Recurrent episodes of AOM
Persistent otorrhea
Concerns toward mastoiditis or other AOM complications
Perceived need for tympanocentesis and/or myringotomy
Abnormal audiological evaluation

💊 Recommended Adult Outpatient Dosage

Antibiotic	Dosing Selection	Duration	Status
Amoxicillin	500mg PO q8h	5 – 7 Days	Preferred
Amoxicillin / Clavulanate	625mg PO q8h	5 – 7 Days	Alternative
Erythromycin Ethylsuccinate	400mg PO q6h OR 800mg PO q12h	5 – 7 Days	Alternative

👶 Pediatric Severity & Risk Filtering

Assess age and structural features to determine threshold for immediate treatment.

Immediate Pediatric Antibiotic Indications (Severe Group):

Perforated TM, moderate-to-severe otalgia, Temp ≥ 39°C, age < 6 months old, bilateral AOM in a child under 2 years old, or co-existing craniofacial abnormalities.

Age < 2 Years Old

Antibiotic Duration: 7 – 10 Days

Requires longer therapeutic course to prevent relapse and complications.

Age ≥ 2 Years Old

Antibiotic Duration: 5 – 7 Days

Standard duration appropriate if child has no major anatomical or immune risk factors.

👶 Pediatric Antibiotic Dosing Reference

Guideline-compliant mg/kg weight-based calculations and treatment durations.

Antibiotic	Dosing Specification	Duration	Clinical Remarks
Amoxicillin	80 – 90 mg/kg/day PO split q8h or q12h (Max: 1g/dose, 3g/day)	< 2 years: 7 – 10 Days ≥ 2 years: 5 – 7 Days	Preferred
Amoxicillin / Clavulanate (Formulation 14:1)	80 – 90 mg/kg/day PO split q12h (Amoxicillin component; Max: 3g/day)	< 2 years: 7 – 10 Days ≥ 2 years: 5 – 7 Days	Alternative Preferred choice if amoxicillin exposure occurred within the past 30 days. Less likely to cause diarrhea.
Amoxicillin / Clavulanate (Formulation 7:1)	40 – 50 mg/kg/day PO split q12h (Amoxicillin component; Max: 3g/day)	< 2 years: 7 – 10 Days ≥ 2 years: 5 – 7 Days	Alternative ⚠️ May not be adequate to treat AOM due to penicillin non-susceptible S. pneumoniae.
Erythromycin Ethylsuccinate	40 – 50 mg/kg/day PO split q12h (Max: 800mg/dose)	< 2 years: 7 – 10 Days ≥ 2 years: 5 – 7 Days	Alternative

💉 Preventative Counseling

Ensure the pneumococcal conjugate vaccine (PCV) is administered to all children according to the national recommended immunization schedule to reduce future AOM burdens.