This handout is for acute otitis media (ent/em lens). Your care team identified this based on: acute ear pain (ear-tugging/irritability in a preverbal child) often after/with a viral uri — the commonest aom presentation (aap 2013 lieberthal; rothman jama 2003 — ear pain lr+ 3.0-7.3).
Other reasons your team may use this plan: new acute purulent otorrhoea through a perforated tm (not a swimmer / canal-traction-tender ear) — aom with perforation; one aap 2013 diagnostic pathway by itself; bulging / cloudy / distinctly immobile tm on (pneumatic) otoscopy — the strongest objective aom finding (rothman jama 2003 — bulging adjusted lr+ 51, cloudy 34, immobile 31); recurrent aom (≥3 episodes/6 mo or ≥4/12 mo with ≥1 in the prior 6 mo) — tympanostomy-tube referral entry (aao-hns rosenfeld 2022; aap 2013).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| ibuprofen | 10 mg/kg (max 400-600 mg adult) | PO | q6-8h PRN | AAP 2013 Lieberthal — analgesia is a primary AOM recommendation independent of antibiotics; ibuprofen first-line for otalgia ≥6 mo |
| acetaminophen | 15 mg/kg (max 1 g adult) | PO | q4-6h PRN | AAP 2013 Lieberthal — acetaminophen first-line analgesia; usable <6 mo where NSAIDs are restricted |
| topical_anaesthetic_analgesic_ear_drops_if_TM_intact | — | — | — | NICE NG91 [2022] — anaesthetic/analgesic ear drops as adjunct when TM intact and no perforation; do NOT use if perforation/otorrhoea |
Plan: AOM — analgesia (always) + observe-vs-antibiotic decision + escalation ladder
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Post-AOM hearing/effusion surveillance — persistent MEE ≥3 mo or hearing concern → audiology + OME pathway (AAO-HNS Rosenfeld 2022). Recurrent AOM (≥3/6 mo or ≥4/12 mo with ≥1 recent) with MEE present → ENT tympanostomy-tube referral (Venekamp Cochrane 2018 — tubes vs active monitoring NNT ~3 at 6 mo). Modifiable-risk counselling: avoid supine bottle-feeding, tobacco-smoke exposure, ensure pneumococcal + influenza immunisation; breastfeeding is protective (AAP 2013 prevention section).
Guideline: AAP 2013 AOM Clinical Practice Guideline (Lieberthal et al, Pediatrics 2013, PMID 23439909 — current US authority, no 2024-2026 replacement, WebSearch-verified 2026-05-17) + NICE NG91 Otitis media (acute): antimicrobial prescribing (2018, updated 2022, sepsis-link refresh Nov 2025) + AAO-HNS Tympanostomy Tubes in Children Update (Rosenfeld 2022, PMID 35138954) + Cochrane antibiotics-for-AOM (Venekamp 2023, PMID 37965923) + Rothman JAMA 2003 Rational Clinical Examination (otoscopy likelihood ratios) + Tähtinen/Hoberman NEJM 2011 placebo RCTs + 2024 Italian intersociety AOM consensus (freshness cross-check)