Otitis media
Analgesia, no antibiotic treatment (majority resolve in 24 hrs)
500mg every 8 hours for 5 days
500mg every 8 hours for 5 days
If penicillin allergic, prescribe doxycycline
200mg on day 1, then 100mg daily for 5 days treatment in total
For penicillin allergy in pregnancy
500mg every 6 hours for 5 days
500mg every 6 hours for 5 days
Prescribing Notes:
- Antibiotics do not reduce pain in the first 24 hours, and make no difference to the likelihood of a further infection or hearing difficulty.
- Consider antibiotics if any of the following are present: systemic toxicity, otorrhoea, recurrent ear infection, immunocompromised, debilitated or prolonged illness (more than 2-3 days). In other cases consider withholding prescription or give delayed prescription.
History Notes
06/06/2024
Erythromycin ethyl succinate 500mg/5ml oral suspension sugar free discontinued and removed
15/12/2021
East Region Formulary content agreed.
Analgesia, no antibiotic treatment (60% resolve in 24 hrs).
See BNFc for dose, duration 5 days.
See BNFc for dose, duration 5 days.
See BNFc for dose, duration 5 days.
See BNFc for dose, duration 5 days.
If penicillin allergic, prescribe clarithromycin.
See BNFc for dose, duration 5 days.
See BNFc for dose, duration 5 days.
See BNFc for dose, duration 5 days.
See BNFc for dose, duration 5 days.
Prescribing Notes:
- Antibiotics do not reduce pain in the first 24 hours and make no difference to the likelihood of a further infection or hearing difficulty.
- Consider antibiotics if any of the following are present: systemic symptoms, recurrent ear infection, immunocompromised, debilitated or prolonged illness (more than 2-3 days).
- Consider a delayed prescription (2-3 days), or immediate antibiotics for pain relief for:
- patients with otorrhoea;
- patients less than 2 years old with bilateral acute otitis media, bulging membrane.
- patients with a symptom score >8 where 0 = no symptoms; 1 = a little; 2 = a lot. Symptoms include: fever; tugging ears; crying; irritability; difficulty sleeping; less playful; eating less.
- Oral antibiotics are recommended for acute otitis media in patients where the affected ear is the only hearing ear and in patients with a cochlear implant.
- Erythromycin is not indicated for otitis media because it is not effective against Haemophilus influenzae; clarithromycin is the drug of choice for penicillin allergic patients.
- For more information refer to NICE CKS: Otitis media – acute.
History Notes
15/01/2024
East Region Formulary content agreed.