Should Antibiotics Be Prescribed for Acute Otitis Media?

Background

Acute otitis media (AOM) accounts for nearly 15 million antibiotic prescriptions every year and has become the most commonly cited reason for antimicrobial therapy among children in the United States. With the continuing rise of health care costs and the emergence of multi–drug-resistant bacteria, overuse of antibiotics has become a major public health concern worldwide. As a result, experts have called for the judicious use of antimicrobials in the treatment of AOM. However, despite years of clinical experience with the disease, an optimal treatment strategy is still unclear, as the clinical decision to treat or not to treat children with AOM remains controversial.

Best Practice

When medical therapy is deemed necessary for AOM, amoxicillin is considered the first-line treatment due to its safety, low cost and narrow microbiologic spectrum. In patients who have severe illness (moderate to severe otalgia or fever of 39°C or higher) amoxicillin-clavulanate should be used. Currently, immediate antibiotic therapy is recommended in children younger than six months of age, whereas watchful waiting is advocated in children older than six months of age with nonsevere illness. However, two recent studies using more stringent diagnostic criteria for AOM have shown significantly better outcomes with immediate antibiotic therapy in children between six and 35 months of age. These studies highlight the importance of accurate diagnosis of AOM in choosing therapeutic intervention, and their findings may lead to a reevaluation of the watchful waiting strategy. Read the full article in The Laryngoscope.