[Treatment of acute otitis media]

Abstract

The treatment of acute otitis media (AOM) has three main aims: to relieve pain, to control fever and in case of suppurative AOM, to overcome the bacterial infection. The two former aims are best managed with salicylates or paracetamol. The local instillation of drops of an anaesthetic-antiseptic solution in the external canal is a useful adjuvant in painful congestive viral otitis. Antibiotherapy is only indicated in suppurative AOM. The most common organisms being Haemophilus influenzae and Streptococcus pneumoniae, amoxicillin is the first line treatment. However, in children who were treated for suppurative AOM in the previous months, amoxicillin/clavulanic acid or a second generation cephalosporin is preferable. Erythromycin-sulfonamide may also be used, particularly in children who are allergic to beta-lactamines. In case of failure of the first choice antibiotic treatment, it is necessary to perform a bacteriological study of the effusion which will determine the appropriate antibiotic to be used in second hand. The duration of the antibiotic treatment must be of 8 days in the absence of spontaneous perforation, and of 10 days in case of perforation. An examination of the tympanum at 10 days is recommended in infants under 6 months of age and in children with repeated AOM. A myringostomy is only indicated when a bacteriological evaluation is needed, mainly in infants under 6 months of age, in immuno-compromised children, and in case of failure of a first line antibiotic treatment.