From the Guidelines
The treatment for acute otitis media (AOM) in pediatric patients is primarily focused on pain management and, in certain cases, antibiotic therapy.
Key Considerations
- Pain management is a crucial aspect of AOM treatment, as antibiotics do not provide symptomatic relief in the first 24 hours, and analgesics can relieve pain associated with AOM within 24 hours 1.
- Antibiotic therapy is recommended for children with severe, persistent, or recurrent infections, and for those with certain risk factors, such as bilateral AOM or otorrhea 1.
- Watchful waiting is an optional approach for mild to moderate AOM, with a mechanism in place for follow-up and initiation of antibiotics if the child worsens or fails to improve within 48 to 72 hours of AOM onset 1.
Treatment Guidelines
- For children 6 months to 2 years old, antibiotic therapy is recommended for unilateral or bilateral AOM, with amoxicillin-clavulanate being a commonly used antibiotic 1.
- For children 2 years and older, antibiotic therapy is recommended for bilateral AOM or AOM with otorrhea, while watchful waiting may be considered for unilateral AOM 1.
- The American Academy of Pediatrics (AAP) provides a framework for clinical decision-making, emphasizing accurate diagnosis, judicious use of antibiotics, and consideration of the child's individual needs and risk factors 1.
Important Considerations
- Analgesics should be used to relieve pain associated with AOM, regardless of whether antibiotic therapy is prescribed 1.
- Antibiotic resistance is a concern, and antibiotics should be used judiciously and only when necessary 1.
- Follow-up is essential to monitor the child's condition and adjust treatment as needed 1.
From the Research
Treatment Options for Acute Otitis Media (AOM) in Pediatric Patients
- The treatment of choice for AOM is antibiotic therapy, with amoxicillin being the most commonly prescribed antibiotic 2, 3, 4.
- However, due to increasing antibiotic resistance, the Centers for Disease Control and the American Academy of Pediatrics recommend the judicious use of antibiotics in the treatment of AOM 2, 5.
- Alternative antibiotics, such as cephalosporins (e.g. cefuroxime axetil, cefdinir, and cefpodoxime proxetil), may be considered for children who are allergic to amoxicillin or have a high likelihood of infection with an amoxicillin-resistant pathogen 2.
- A delayed prescribing strategy, where antibiotic therapy is delayed for 48-72 hours after diagnosis, may be an effective approach for managing AOM in children, with only 24-30% of patients requiring antibiotic therapy 5, 3.
- Watchful waiting, with a focus on treating pain and monitoring symptoms, may be a suitable approach for children with mild to moderate AOM 3, 4.
- The use of vaccines, such as the influenza vaccine and pneumococcal vaccine, may help reduce the incidence of AOM in children 3, 6.
Antibiotic Treatment Guidelines
- The American Academy of Pediatrics and American Academy of Family Physicians have released guidelines for the treatment of AOM in children, which emphasize the importance of distinguishing AOM from otitis media with effusion and minimizing the use of antibiotics 2, 5.
- The guidelines recommend that antibiotic therapy be reserved for children with severe AOM or those who are at high risk for complications 2, 5.
- The choice of antibiotic and duration of treatment should be based on the severity of the infection, the likelihood of antibiotic resistance, and the child's medical history 2, 4.
Considerations for Treatment
- The treatment of AOM should take into account the potential side effects of antibiotic therapy and the impact on long-term sequelae, such as developmental outcomes 6.
- The use of strict diagnostic criteria and judicious use of antibiotic therapy can help direct treatment to only those patients who are likely to benefit 3.
- Parental satisfaction and adherence to treatment are important considerations when selecting a treatment approach for AOM in children 5, 3.