Duration of Antibiotic Therapy

Optimal duration for antibiotic therapy is unclear. However, recommendations are made based on OM severity and age. Such that, treatment for antibiotics is advised for:

• 10 days in children < 2 years old or with severe symptoms
• 7 days in children aged 2-5 years with mild or moderate OM
• 5-7 days in children ≥ 6 years old with mild or moderate OM

National Institute for Health and Care Excellence (NICE) recommendations for therapeutic management with antibiotics for Pediatric OM aged 1 month to 17 years old are as follows:

1. In children and young people less likely to benefit from antibiotic therapy such as children without otorrhea, children < 2 years old with unilateral infection, and otherwise healthy appearing children:

• Relieve pain with paracetamol or ibuprofen
• Consider either:
  • No antibiotics: observe and seek help if symptoms progressively worsen or do not improve after 3 days, or if patient becomes systemically ill
  • Back up antibiotics: use only if symptoms worsen or child shows no improvement within 3 days; seek help if symptoms progressively worsen or if patient becomes systemically ill

2. In children and young people who may benefit from antibiotics such as children of any age with otorrhea and children < 2 years old with bilateral infection

• Relieve pain with paracetamol or ibuprofen
• Consider either:
  • No antibiotics: observe and seek help if symptoms progressively worsen or do not improve after 3 days, or if patient becomes systemically ill
  • Back up antibiotics: use only if symptoms worsen or child shows no improvement within 3 days; seek help if symptoms progressively worsen or if patient becomes systemically ill
  • Immediate antibiotics: seek help if symptoms progressively worsen or if patient becomes systemically ill

3. In children with symptoms and signs manifesting a more serious illness or condition, at high-risk of complications, or who are systemically ill

• Consider either:
  • Immediate antibiotics: seek help if symptoms progressively worsen or if patient becomes systemically ill, and further assessment
  • Referral to hospital if OM is associated with: severe systemic infection or acute complications such as mastoiditis, meningitis, sinus thrombosis, intracranial abscess, or facial nerve paralysis