Quality Department Guidelines for Clinical Care Ambulatory

Therapy of acute otitis media • Recommend adequate analgesia for all children with AOM [I, D*]. • Consider deferring antibiotic therapy for lower risk children with AOM [II, A*]. • When antibiotic therapy is deferred, facilitate patient access to antibiotics if symptoms worsen (e.g., a "back-up" prescription given at visit or a convenient system for subsequent call-in) [I, C*]. • Amoxicillin is the first choice of antibiotic therapy for all cases of AOM. – Children: Dosing: < 4 years, 80 mg/kg/day divided BID; ≥ 4 years, 4060 mg/kg/day [I, C*]. Duration 510 days: 5 days is usually sufficient at lower cost and fewer side effects, although 10 days reduces clinical failure [A*]. Consider 10-day course for young children with significant early URI symptoms, children with possible sinusitis, and children with possible strep throat [II, D*]. – Adults: either 875 mg BID x 10 days or 500 mg 2 tabs BID x 10 days [I, C*]. In the event of allergy to amoxicillin, azithromycin (Zithromax) dosed at 30 mg/kg for one dose is the appropriate first line therapy. • Treat AOM that is clinically unresponsive to amoxicillin after 72 hours of therapy with amoxicillin/clavulanate (Augmentin ES; amoxicillin component 80 mg/kg/day divided BID) for 10 days or with azithromycin (Zithromax) 20 mg/kg daily for 3 days [II, C*]. • Patients with significant, persistent symptoms on high-dose amoxicillin/clavulanate (Augmentin ES) or azithromycin (Zithromax) may respond to IM ceftriaxone (Rocephin; 1-3 doses) [II, C*]. The decision to use ceftriaxone (Rocephin) should take into account the negative impact it will have on local antibiotic resistance patterns.