Pediatric Acute Otitis Media Organism-Specific Therapy 

Updated: Dec 02, 2020
  • Author: Brenda L Natal, MD, MPH; Chief Editor: Thomas E Herchline, MD  more...
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Specific Organisms and Therapeutic Regimens

Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis are the most commonly isolated middle-ear pathogens. Owing to pediatric pneumococcal vaccination, however, the prevalence of pneumococcal serotypes not covered by the vaccines (eg, Alloiococcus otitidis, Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa) are increasingly being isolated in patients with acute otitis media (AOM). [1, 2]   

With regard to treatment duration in children with AOM, there has been debate as to which is optimal, a 5- or 10-day regimen. A trial by Hoberman et al found that young children aged 6-23 months given amoxicillin/clavulanate for 5 days were more likely to have clinical failure compared with those treated for 10 days (34% vs 16% respectively). [3]  

Organism-specific therapeutic regimens for pediatric AOM are provided below, including those for S pneumoniae, H influenzae, M catarrhalis, and viral or sterile effusion. [4, 5, 6, 7, 8, 9, 10, 11, 12]

Streptococcus pneumoniae

Intermediate resistance or penicillin-susceptible:

  • Amoxicillin 80-90 mg/kg/day (maximum 3 g/24h) PO divided BID for 5-10d or

  • Ceftriaxone 50 mg/kg (maximum 1 g) IM × 1 dose

Highly resistant and severe disease with complications:

  • Vancomycin 40 mg/kg/day (maximum 4 g/24h) IV divided q6-8h for 10d

Haemophilus influenzae

See the list below:

  • Amoxicillin-clavulanate 80-90 mg/kg/day (maximum 4 g/24h) PO divided BID for 5-10d or

  • Ceftriaxone 50 mg/kg (maximum 1 g) IM × 1 dose or

  • Cefdinir 14 mg/kg/day (maximum 600 mg/24h) PO daily or divided BID for 5-10d or

  • Cefpodoxime 10 mg/kg/day (maximum 400 mg/24h) PO daily or divided BID for 5-10d or

  • Cefuroxime 30 mg/kg/day (maximum 1 g/24h) PO divided BID for 5-10d

Moraxella catarrhalis

See the list below:

  • Amoxicillin-clavulanate 80-90 mg/kg/day (maximum 4 g/24h) PO divided BID for 5-10d or

  • Ceftriaxone 50 mg/kg (maximum 1 g) IM × 1 dose or

  • Cefdinir 14 mg/kg/day (maximum 600 mg/24h) PO daily or divided BID for 5-10d or

  • Cefpodoxime 10 mg/kg/day (maximum 400 mg/24h) PO daily or divided BID for 5-10d or

  • Cefuroxime 30 mg/kg/day (maximum 1 g/24h) PO divided BID for 5-10d

Viral or sterile effusion

See the list below:

  • None