Clinical Pathway for Evaluation/Treatment of Suspected
Acute Otitis Media in Children 2 Months to 12 Years

Suspected Acute Otitis Media (AOM)
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 hours
Severe or otorrhea from TM perforation
< 6 mos
6-23 mos
≥ 2 yrs

Treat immediately

Durations by Age

Antibiotic Recommendations

Recommend 48-72 hrs observation

Consider safety-net antibiotic prescription (SNAP)

Durations by Age for SNAP

Antibiotic Recommendations
Antibiotic Durations by Age
< 2 yrs 10 days
2-5 yrs 7 days
≥ 6 yrs 5 days
Posted: November 2008
Revised: March 2023
Authors: B. Ku, MD; G. Lawton, MD; S. Mittal, MD; L. Marlowe, MD; E. Huang, MD; L. Rodriguez, PharmD;
T. Metjian, PharmD; K. Chiotos, MD; J. Gerber, MD; R. Same, MD; J. Lavelle, MD