CKS OM
NICE feverish children

Haemophilus is an extracellular pathogen, thus macrolides, which concentrate intracellularly, are less effective treatment.

Optimise analgesia and target antibiotics.

AOM resolves in 60% in 24hrs without antibiotics, which only reduce pain at 2 days (NNT15) and does not prevent deafness.  

FIRST LINE: consider eardrops containing an anaesthetic and an analgesic for pain if:

• an immediate oral antibiotic prescription is not given and
• there is no eardrum perforation or otorrhoea.

Review treatment if symptoms do not improve within 7 days or worsen at any time.

Consider 2 or 3-day delayed or immediate antibiotics for pain relief if: 

• <2 years AND bilateral AOM (NNT4)
• OR bulging membrane or symptom score above 8 for: fever, tugging ears, crying, irritability, difficulty sleeping, less playful, eating less
  (0 = no symptoms, 1 = a little, 2 = a lot).

Provide safety net advice.

NNT

• All ages with otorrhoea NNT = 3.  
• Antibiotics to prevent mastoiditis NNT >4000

For further information on children see Empiric Antibiotic Therapy poster.

For glossary of terms see Glossary.