Management of acute otitis media in patients who do not require antibiotic therapy

For patients with acute otitis media who are unlikely to benefit from antibiotic therapy, give adequate pain relief alone. For child dosages, see Oral drugs for mild, acute nociceptive pain in children, or for adult dosages, see Oral drugs for mild, acute nociceptive pain in adults.

Effective communication with the patient or carer about the limited role of antibiotic therapy for acute otitis media is essential. Discuss the following with the patient or carer:

• Acute otitis media is usually self-limiting. Complications (eg mastoiditis) are rare and not prevented by antibiotic therapyNational institute for Health and Care Excellence (NICE), 2018Venekamp, 2015.
• Symptoms usually resolve or improve within 2 to 7 days without antibiotic therapyNational institute for Health and Care Excellence (NICE), 2018Australian Commission on Safety and Quality in Health Care (ACSQHC), 2023.
• The criteria for follow-up and reassessment. Ask the patient to return in 2 days if symptoms do not improve, or earlier if symptoms worsen or if symptoms suggestive of complicated infection occur.
• If there is an expectation to receive an antibiotic prescription, discuss misconceptions about the effectiveness of antibiotic therapy, and the potential harms of antibiotic therapy.

A decision aid for consumers to support discussions is available from the Australian Commission on Safety and Quality in Health Care (ACSQHC).