Full Title: Management of Acute Otitis Media, Update
Expected Release Date: late 2009
Key Questions
- What is the validity of clinical symptoms and otoscopic findings such as a bulging tympanic membrane to diagnose acute otitis media (AOM)? Do these clinical findings aid physicians in distinguishing AOM from otitis media with effusion (OME)?
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- What organisms (bacterial and viral) are associated with otitis media since the introduction of pneumococcal conjugate vaccine (PNC7)?
- What are the patterns of antimicrobial resistance since the introduction of PNC7?
- New infections.
- Recurrent infections.
What is the comparative effectiveness of different treatment options (defined below) for treating AOM in average risk children ages <2 years, ages 2 years to <5years and ages >5 years?
Treatment options include but not limited to:
- Amoxicillin (including high dose versus low dose).
- Amox-clav (including high dose versus low dose).
- Cephalosporins (e.g. ceftriaxone, cefdinir, cefixime).
- "Wait and see approach".
- Placebo.
- Duration of treatment.
Outcomes to consider but not limited to:
- Parent satisfaction.
- Duration of symptoms/illness.
- Treatment failure, mastoiditis, bacteremia, clinical cure, bacteriologic cure.
- Disease recurrence.
What is the comparative effectiveness of different management options for recurrent otitis media?
Management options include but not limited to:
- Amox-clav.
- Cephalosporins (e.g. ceftriaxone, cefuroxime).
- Quinolones.
- Antibiotic prophylaxis.
Outcomes to consider but not limited to:
- Parent satisfaction.
- Duration of symptoms/illness.
- Treatment failure, mastoiditis, bacteremia/cure rates.
What is the evidence that the comparative effectiveness of different treatment options in KQ #33 differs in subpopulations of patients?
Subpopulations to include (but not limited to):
- Bilateral disease.
- Commorbidities (e.g. asthma -will need to define further).
- Age groups (e.g. <1 month, 1-<2 mos, 2-<6 mos, 6 mos-<2 years, 2-5 years).
- Race/Ethnicity.
- Day care attendance.
What are the comparative harms of different treatment options?
Outcomes to consider (but not limited to):
- Antibiotic resistance.
- Diarrhea/vomiting.
Current as of June 2008
Internet Citation:
Management of Acute Otitis Media, Update, Clinical Focus. June 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/otitisuptp.htm