Clinical Brief: Treatment of Otitis Media

Educational Objectives

The goal of this program is to improve otitis media. After hearing and assimilating this program, the clinician will be better able to:

1. Outline the treatment of acute otitis media.

Summary

Otitis media (OM): in children, 25% of antibiotics (AB) prescribed are for OM; peak incidence is 6 to 15 mo of age; 80% of children experience OM during their lifetime; AB stewardship can prevent future complications (eg, deafness) and the need for tympanostomy tubes

Duration of AB therapy: in uncomplicated cases, AB therapy for 5 days is effective; in complicated cases, a 10-day course is recommended

Treatment: observation is an option for older children with signs of OM who appear generally healthy; for children <2 yr of age, AB therapy is recommended; for pain management, nonsteroidal anti-inflammatory drugs or acetaminophen (eg, Actamin, Pharbetol, Tylenol) can be used; the first-line therapy is high-dose amoxicillin (80-90 mg/kg per day in 2 divided doses); if the child has received amoxicillin in the past 30 days (treatment failure) or has concomitant purulent conjunctivitis, amoxicillin plus clavulanic acid (Augmentin) is recommended; allergy to penicillin — cefdinir or azithromycin is recommended; recent data show 1% to 2% (not 10%) cross-reactivity with cephalosporins

Prevention: xylitol (a sugar substitute) can help in children prone to OM (limited evidence); xylitol should be used every day for the entire season; other measures include eliminating exposure to tobacco smoke, avoiding supine bottle feeding, and avoiding pacifiers >6 mo of age

OM in adults: AB therapy is recommended, as evidence for observation is limited

Readings

Azarpazhooh A, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2016;2016(8):CD007095. doi:10.1002/14651858.CD007095.pub3; Chiron A, Gaouar H, Autegarden JE, et al. Cross-reactivity with third and second generation cephalosporins in truly penicillin allergic patients. World Allergy Organization Journal. 2020;13(8). doi:10.1016/j.waojou.2020.100245; Katz SE, Jenkins TC, Stein AB, et al. Durations of antibiotic treatment for acute otitis media and variability in prescribed durations across two large academic health systems. J Pediatric Infect Dis Soc. 2024;13(9):455-465. doi:10.1093/jpids/piae073. View Article; Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-999. doi:10.1542/peds.2012-3488; Pichichero ME, Marsocci SM, Murphy ML, et al. A prospective observational study of 5-, 7-, and 10-day antibiotic treatment for acute otitis media. Otolaryngol Head Neck Surg. 2001;124(4):381-387. doi:10.1067/mhn.2001.114311. View Article.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose. Dr. Cheng's lecture includes information related to the off-label or investigational use of a therapy, product, or device.

Acknowledgements

Dr. Cheng was recorded exclusively for Audio Digest on October 24, 2024. Audio Digest thanks the speakers and presenters for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.25 CE contact hours.

Lecture ID:

FP730403

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.