Antibiotic regimens for acute otitis media
For treatment recommendations for Aboriginal and Torres Strait Islander children, see the Otitis Media Guidelines for Aboriginal and Torres Strait Islander Children.
Antibiotic therapy is not required for most patients with acute otitis media. The amoxicillin regimens below are only suitable for patients 1 month or older; seek expert advice for neonates with acute otitis media.
For children with acute otitis media who are likely to benefit from antibiotic therapy, useCentral Australian Rural Practitioners Association (CARPA), 2017Leach, 2020Venekamp, 2015:
1amoxicillin 15 mg/kg up to 500 mg orally, 8-hourly for 5 days; see advice on patient review and modification of therapy amoxicillin
OR if adherence to an 8-hourly regimen is unlikely
1amoxicillin 30 mg/kg up to 1 g orally, 12-hourly for 5 days; see advice on patient review and modification of therapy. amoxicillin
Do not use lower amoxicillin doses because they will not achieve adequate plasma and tissue concentrations to treat resistant Streptococcus pneumoniae strains.
For children who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use:
cefuroxime (child 3 months or older) 15 mg/kg up to 500 mg orally, 12-hourly for 5 days1; see advice on patient review and modification of therapy. cefuroxime
For children who have had a severe (immediate or delayed)2 hypersensitivity reaction to a penicillin, or if a suitable formulation of cefuroxime is not available, use:
trimethoprim+sulfamethoxazole (child 1 month or older) 4+20 mg/kg up to 160+800 mg orally, 12-hourly for 5 days; see advice on patient review and modification of therapy. trimethoprim + sulfamethoxazole
Acute otitis media rarely occurs in adults; antibiotic management is similar to that in children.