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This pre-referral guideline covers Otitis media – acute suppurative otitis media (ASOM) in children of all ages.

Initial work-up

• History – very often preceded by a viral respiratory tract infection
• Physical examination
  • Middle ear effusion – loss of normal tympanic membrane translucency
  • Loss of light reflex
  • Yellowish discolouration tympanic membrane
• Ear discharge if present – swab microscopy/culture/sensitivity if indicated.

Pre-referral treatment

• Adequate analgesia - paracetamol 15 mg/kg 4-6 hourly (max 90 mg/kg/day) as required.
• Acute symptoms usually resolve within 24 hours in most cases
• Antibiotics: commence if distress continues beyond 24-48 hours or if the child is more unwell initially- amoxicillin 15 mg/kg(max 500 mg) orally, 8 hourly for 5 days or Erythromycin 15 mg/kg(max 500 mg) orally, 8-hourly for 5 days if allergic to penicillin.
• Be cautious of accepting ASOM as the sole diagnosis in an unwell infant with a fever.

When to refer

• If medical treatment has been unsuccessful and the child remains symptomatically unwell.
• Bring results of investigations done.
  

Referral form (pdf)

Parent handout (pdf)

Resources

Kids Connect (RCH Primary Care Liaison)

Kids Health Info (Parent fact sheets online)

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References

Paediatric Handbook Ear, Nose and Throat Conditions, Chapter 21 (pp312-324); Robert Berkowitz and Michael Marks; Seventh Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia