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Acute Otitis Media Clinical Pathway – All Settings

Clinical Pathway for Evaluation/Treatment of Suspected
Uncomplicated Acute Otitis Media in Children 2 mos to 12 yrs

Suspected Uncomplicated Acute Otitis Media (AOM)
 
 

Diagnostic Criteria for AOM

For isolated otorrhea with tympanostomy tubes,
topical antibiotic drops only
 
 

Assess Severity or Presence of Otorrhea from TM Perforation

  • Severe disease, any one of:
    • Temperature ≥ 39°C (102.2°F) in past 48 hrs
    • Moderate to severe ear pain
    • Ear pain for ≥ 48 hrs
 
 
 
 
Severe or otorrhea from TM perforation
Non-severe
 
 
 
 
 
 
 
 
< 6 mos
6–23 mos
≥ 2 yrs
 
 
 
 
 
 
 
 
Bilateral
Unilateral
 
 
 
 

Treat immediately

Antibiotic Recommendations

Durations by Age

Recommend 48–72 hrs observation

Consider safety-net antibiotic prescription (SNAP)

Antibiotic Recommendations

Durations by Age for SNAP
Antibiotic Durations by Age
< 2 yrs 10 days
2–5 yrs 7 days
≥ 6 yrs 5 days
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