Acute Otitis Media (AOM) (Antimicrobial)


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.


  • 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.

Drug details

Ear drops with anaesthetic and analgesic (confirm no eardrum perforation or otorrhoea)

Phenazone 40mg/g with lidocaine 10mg/g (Otigo®) ear drops - apply 4 drops two or three times a day.  

For up to 7 days

First choice oral antibiotic

Amoxicillin - see BNFC for children dosing information.

5 days

Penicillin intolerance

Cefuroxime - see BNFC for Children for dosing information.

5 days

Penicillin Allergy

Clarithromycin - see BNFC for Children for dosing information. 

5 days

Last reviewed: 28/09/2023

Next review date: 28/09/2026

Author(s): Antimicrobial Management Team.

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Alison Macdonald, Antimicrobial Pharmacist.

Document Id: AMT149