Treatment options in guidelines for acute otitis media (AOM) management from seven developing countries
| Country | AFG* | LKA† | TZA | ETH | FJI | ARG | MDA |
|---|---|---|---|---|---|---|---|
| Watchful waiting | − | + | − | − | − | +‡ | +§ |
| ABx therapy—first-line | TMP/SMX or AMOX | AMOX, 30 mg/kg, three times a day | Penicillin V or AMOX, 40 mg/kg, three times a day | AMOX: >6 years—250 mg three times a day; <6 years—125 mg three times a day, ampicillin, 50–100 mg/kg twice a day or 100–200 mg/kg twice a day | AMOX or TMP/SMX, twice a day | AMOX, 80–100 mg/kg, twice a day | AMOX 80–100 mg/kg three times a day, or ampicillin, 80–100 mg/kg, four times a day, or AMOX-CLAV, 50–100 mg/kg, twice a day /three times a day, or CEPH, 25–50 mg/kg, three times a day /four times a day, or CEFT, 70–100 mg mg/kg, twice a day |
| ABx therapy—second-line | − | CLOX, or CEPH | − | AMOX-CLAV | − | AMOX-CLAV, CEFT | − |
| ABx therapy—third-line | − | AMOX-CLAV, CEFR, CEFT | − | − | − | − | − |
| Duration (days) | 5–7 | 5–7 | 7 | 10 | 5 | 5–10 | 7–10 |
| Myringotomy | − | − | +/− | +/− | − | +/− | − |
| Systemic analgesics | + | + | + | + | − | + | + |
| Local analgesics | − | − | − | − | − | − | + |
| Local/systemic decongestants | − | − | + | − | − | − | + |
| Steroids | − | − | − | − | − | − | − |
| Antihistamines | − | − | − | − | − | − | + |
| CAM | − | − | − | − | − | − | |
| Other | Ear cleaning if otorrhoea present | − | − | − | − | − | − |
*Guideline distinguishes between children <5 or >5 years for length of treatment: 5 and 7 days, respectively.
†Treatment is correlated to patient's age (<6 or >6 years) and severity of disease.
‡Watchful waiting for 72 hours is possible in a child >2 years, with mild unilateral AOM and without comorbidities.
§Watchful waiting for 72–96 hours is possible; however, antibiotic treatment is indicated when there is no effect anti-inflammatory for 3 days, AOM during the last month or antibiotic therapy during the last month, child age >1 year or recurrent AOM episodes.
ABx, antibiotic; AFG, Afghanistan; AMOX-CLAV, amoxicillin-clavulanate; ARG, Argentina; CAM, complementary and alternative medicine; CEFR, cefuroxime axetil; CEFT, ceftriaxone; CEPH, cephalexin; CLOX, cloxaciliin; ETH, Ethiopia; FJI, Fiji; LKA, Sri Lanka; MDA, Moldova;TMP/SMX, trimethoprim/sulfamethoxazole; TZA, Tanzania.