Change of Course?: Studies point to antibiotics as optimal treatment for otitis media

The question of how soon to give antibiotics to children with acute otitis media (AOM) is receiving renewed attention with the publication of two studies that show the benefit of immediate treatment over the “wait-and-see” approach recommended in the 2004 guidelines of the American Academy of Pediatrics and the American Academy of Family Physicians (AAP/AAFP) (Pediatrics. 2004;113:1451-1465).

The new studies, one from Pittsburgh (N Engl J Med. 2011;364:105-15) and the other from Finland (N Engl J Med. 2011;364:16-26), both show a significant reduction in symptoms and clinical failure rates in children with AOM who were younger than two years of age and were treated with antibiotics compared to those who were not treated.

For most physicians in the U.S. who continued immediate treatment of AOM with antibiotics even after the 2004 recommendations, the new studies add weight to that decision. Physicians who have adopted a “wait-and-see” approach, largely in response to growing concern over the antibiotic overuse and multi-drug resistant bacteria that helped drive the 2004 recommendations, may need to rethink which children to observe before initiating treatment if necessary.