In acute otitis media, antibiotic selection is directly shaped by the patient's allergy history. When penicillin is contraindicated, the treatment path changes — and the choice of analgesic and antibiotic must reflect that constraint from the outset.
This protocol applies to acute otitis media presenting with acute onset, presence of middle ear effusion, and physical evidence of middle ear inflammation — accompanied by ear pain, irritability, or fever — in a patient with a known penicillin allergy.
Management begins with adequate analgesia for ear pain, fever, and irritability — ibuprofen is the preferred analgesic. Given the penicillin allergy, an oral cephalosporin is selected as the antibiotic. The specific agent and full regimen are in the protocol below.
Improvement or resolution of acute otitis media symptoms — including ear pain and fever — within 48 to 72 hours.