Correct Answer:

amoxicillin 90 mg/kg/day for 10 days

Educational Objective:

Infants aged < 6 months with acute otitis media should be treated with antibiotics.

Key Point:

Haloperidol plus lorazepam is the preferred combination in patients with undifferentiated severe agitation. The intramuscular route is preferred in uncooperative patients.

Explanation:

Infants younger than 6 months of age with acute otitis media (AOM) should be treated with antibiotics. High-dose amoxicillin at a dose of 90 mg/kg/day is preferred over lower doses due to the effectiveness of the higher dose against most strains of Streptococcus pneumoniae. If the infant has risk factors for resistant pathogens, such as recent antibiotic use, then amoxicillin/clavulanate or ceftriaxone is preferred.

Guidelines published in 2013 by the American Academy of Pediatrics and American Academy of Family Physicians recommend antibiotic treatment for infants aged younger than 6 months, children with severe signs or symptoms, and children aged younger than 2 years with bilateral infection. The guidelines permit observation as an option for children who are aged between 6 and 24 months and have unilateral, nonsevere otitis media and for children aged older than 24 months with nonsevere unilateral or bilateral AOM.

Oral decongestants have not been shown to provide any benefits and should not be routinely used in infants and children.

References:

Kershner J, Preciado D. Otitis media (chapter 640). In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 20th ed., 2016:3085-3100.

Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131:e964.