University of Michigan Medical School
Continuing Medical Education (CME)

Otitis Media in Children and Adults

Introduction to this self-study CME activity


Otitis media is one of the most common diagnoses made by pediatricians. However, a great deal of variability remains in diagnostic criteria, approaches to therapy, and follow-up. This self-study activity provides practical guidance to clinicians about diagnosing and treating otitis media based on available empirical evidence.

Key and newer aspects of care that are elaborated in the guideline include:

  • Deferring antibiotic therapy should be considered for children age 2 and older with acute otitis media (AOM) and mild to moderate symptoms.
  • Analgesic therapy should be recommended for all children with AOM
  • When antibiotic therapy is deferred, facilitate patient access to antibiotics if symptoms worsen (e.g., a "back-up" prescription given at visit or a convenient system for subsequent call-in).
  • For children with AOM unresponsive to amoxicillin, either amoxicillin/clavalanate or high dose azithromycin are appropriate second line therapies.
  • Oral cephalosporins should not be used to treat AOM
  • Referral to otolaryngology should be made based on the symptoms of OME or concern for anatomic damage to middle ear structures, rather the simple duration of the effusion

When medical antibiotic treatment is indicated:

  • High dose amoxicillin is the first choice of antibiotic therapy for all cases of AOM. 
    • For children under 4 years of age, 80 mg/kg/day divided BID for 5- 10 days.
    • For children 4 years of age or older, 40- 60 mg/kg/day is probably adequate.
    • For adults, either 875 mg BID x 10 days or 500 mg 2 tabs BID x 10 days.
  • Treat AOM that is clinically unresponsive to amoxicillin after 72 hours of therapy with either:
    • amoxicillin/clavulanate – pediatric 80 mg/kg divided BID x 10 days; adult 875/125 mg BID x 10 day
    • azithromycin – pediatric 20 mg/kg daily for 3 days; adult 1 g daily for 3 days
  • Patients with persistent symptoms on these agent should receive: ceftriaxone – pediatric 50-75 mg/kg/day IM x 1-3 days; adult 1-2g IM/IV daily x 1-3 days.  The decision to use ceftriaxone should take into account the possible impact of this antibiotic on patterns of antibiotic resistance. 


This self-study activity is appropriate for primary care clinicians and other health care providers who diagnosis and treat otitis media in children and adults.


Team Leader

Richard Linsk, MD
General Pediatrics


Team Members

Alexander Blackwood, MD
     Pediatric Infectious Disease
James Cooke, MD
Family Medicine

Van Harrison, PhD
 Medical Education
Peter P. Passamani, MD
 Pediatric Otolaryngology

Author Disclosures
  Neither the members of the members of guideline team nor the consultants have relationships with commercial companies whose products are discussed in this guideline.

Other Acknowledgements

UMHS Guidelines Oversight Team: William E. Chavey, MD
Van Harrison, PhD
Literature search services: Taubman Medical Library
Production of Internet format and web site maintenance: Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA/PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This CME activity was released in July 2007 with credit available through June 2010.  It was reviewed for currency of content in June 2010 with availability of credit extended through June 2013. 

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.


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