| 1. |
Classify episodes of otitis media (OM) as acute otitis media (AOM) or otitis media with effusion (OME). Only treat certain children proven AOM. |
| 2. |
A certain diagnosis of AOM meets three criteria: |
 |
History of acute onset of signs and symptoms |
|
Presence of middle ear effusion |
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Signs or symptoms of middle-ear inflammation |
| Severe illness is moderate to severe otalgia or fever is 39C or greater. |
| Non-severe illness is mode otalgia and fever is 39C or less in the past 24 hours. |
| 3. |
Children with AOM who should be treated as follows: |
|
Age less than 6 months:
certain and uncertain diagnosis - antibacterial therapy |
|
Age 6 months to 2 years:
certain diagnosis - antibacterial therapy
uncertain diagnosis - anitbacterial therapy if severe illness; observatioin option* if nonsevere illness |
|
Age 2 years or older:
certain diagnosis - anitbacterial therapy if severe illness; observatioin option* if nonsevere illness
uncertain diagnosis - Observation option* |
| * If decision is made to treat with an antibacterial agent, the clinician should prescribe amoxicillin for most children. |
| 4. |
Don’t prescribe antibiotics for initial treatment of OME: |
| |
|
treatment may be indicated if bilateral effusions persist for 3 months or more. |
