Indication Comment Drug Dose Duration Acute Otitis Many infections are caused by viruses. First choice media Optimise analgesia No antibiotics - and “Wait Avoid antibiotics as 60% are better in 24 hours without: they only reduce pain at see” recommended for 72 hrs 2 days (NNT15) and do not prevent deafness Consider 2 or 3-day-delayed or immediate antibiotics if: Alternative Choice < 2yrs with bilateral AOM (NNT4) or bulging membrane and 4 marked Amoxicillin Neonate 7- 28 days: 5 days ≥ symptoms 30 mg/kg tds All ages with otorrhoea (NNT3) 1 month 1 year: – Antibiotics to prevent Mastoiditis NNT >4000 125mg tds 1-5 years: 250mg tds >5 yrs: 500mg tds If allergic to Penicillin: Clarithromycin Adult &child >12 yrs: 500mg bd 5 days Children <12yrs: Dose dependent on age and body weight. 5 days See Alternative in children <12yrs 1 mth - 1yr: Erythromycin suspension 5 days qds 2-7 yrs qds 8-12 yrs 250 -500mg qds Indication Comment Drug Dose Duration Otitis externa Remove or treat any precipitating or aggravating factors. First choice acute Exclude an underlying chronic OM before treating Aural toilet – Use analgesia and toilet first line Avoid ear drops containing an aminoglycoside if the tympanic membrane is Mild perforated Acetic acid 2% 1 spray tds 7 days Cure similar at 7 days for topical acetic acid or antibiotic +/- steroid Alternative choices
Indication Comment Drug Dose Duration Acute Otitis media Many infections are caused by viruses. Optimise analgesia Avoid antibiotics as 60% are better in 24 hours without: they only reduce pain at 2 days (NNT15) and do not prevent deafness Consider 2 or 3-day-delayed or immediate antibiotics if: < 2yrs with bilateral AOM (NNT4) or bulging membrane and ≥ 4 marked symptoms All ages with otorrhoea (NNT3) Antibiotics to prevent Mastoiditis NNT >4000 First choice No antibiotics - “Wait and see” recommended for 72 hrs Alternative Choice Amoxicillin If allergic to Penicillin: Clarithromycin Alternative in children <12yrs Erythromycin suspension Neonate 7- 28 days: 30 mg/kg tds 1 month – 1 year: 125mg tds 1-5 years: 250mg tds >5 yrs: 500mg tds Adult &child >12 yrs: 500mg bd Children <12yrs: Dose dependent on age and body weight. See 1 mth - 1yr: qds 2-7 yrs qds 8-12 yrs 250 -500mg qds 5 days 5 days 5 days 5 days Indication Comment Drug Dose Duration Otitis externa – acute Remove or treat any precipitating or aggravating factors. Exclude an underlying chronic OM before treating Use analgesia and toilet first line Avoid ear drops containing an aminoglycoside if the tympanic membrane is perforated Cure similar at 7 days for topical acetic acid or antibiotic +/- steroid First choice Aural toilet Mild Acetic acid 2% Alternative choices 1 spray tds 7 days
Doncaster-Bassetlaw-Antimicrobials-Guidelines-for-Primary-Care.docx