 |
|
|
| Get Smart: Know When Antibiotics Work |
|
|
| Home > Healthcare Providers > Otitis Media |
|
 Print-friendly version of this academic detailing sheet (PDF 167 KB)
Careful Antibiotic Use
Otitis Media:
Physician Information Sheet (Pediatrics)
|
Otitis media with effusion does not require antibiotic treatment
Acute otitis media does not always require antibiotic treatment |
|
Otitis Media
Differentiating Acute Otitis Media (AOM) from Otitis Media with Effusion (OME):
A tool for promoting appropriate antibiotic use.1, 2
 |
Always use pneumatic otoscopy or
tympanometry to confirm middle ear effusion |
|
 No effusion
Not OME or AOM |
|
|
|
Yes effusion present |
|
Signs or symptoms of AOM-including ear pain, fever,
and bulging yellow or red TM |
|
| |
AOM |
| • |
History of acute onset of signs and symptoms
WITH |
| • |
The presence of middle ear effusion (indicated by bulging of the TM or limited/absent TM mobility or otorrhea or air-fluid level)
WITH |
| • |
Signs or symptoms of middle-ear inflammation (indicated by distinct erythema of the TM or distinct otalgia) |
|
|
Treatment |
| Management should include assessment of pain → if pain is present, clinician should recommend treatment to reduce pain. |
Age |
Certain Diagnosis |
Uncertain Diagnosis |
| < 6 mo |
Antibacterial therapy |
Antibacterial therapy |
6 mo
to 2 y |
Antibacterial therapy |
Antibacterial therapy if
severe illness; observation
option* if nonsevere illness |
| > 2 y |
Antibacterial therapy if
severe illness; observation
option* if nonsevere illness |
Observation option* |
*Observation is an appropriate option only when follow-up can be ensured and
antibacterial agents started if symptoms persist or worsen. Nonsevere illness is mild otalgia and fever <39°C in the past 24 hours. Severe illness is moderate to severe
otalgia or fever > 39°C. A certain diagnosis of AOM meets all 3 criteria:
- rapid onset,
- signs of middle ear effusion, and
- signs and symptoms of middle-ear inflammation.
|
|
|
OME
Presence of effusion (including immobility
of the tympanic membrane)
WITHOUT
Signs or symptoms of acute infection.
Nonspecific signs and symptoms (rhinitis,
cough, diarrhea) are often present. |
|
Treatment
Antibiotic treatment has not been
demonstrated to be effective in long-term
resolution of OME. A single course of
treatment for 10-14 days may be used
when a parent or caregiver expresses a
strong aversion to impending surgery.
|
|
Share this algorithm with parents.
Explain when the risks of using
antibiotics outweigh the benefits.
Avoiding unnecessary treatment of
OME would save up to 6-8 million
courses of antibiotics each year.3
|
|
If the patient fails to respond to the initial management option within 48-72 hours, clinician must reassess to confirm AOM and exclude other causes of illness. If AOM is confirmed in:
- Patient initially managed with observation, begin antibacterial therapy.
- Patient initially managed with antibacterial agent, change the agent.
|
|
References |
- American Academy of Pediatrics and American Academy of Family Physicians, Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media.
Pediatrics 2004;113(5):1451-65.
- Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz B. Otitis media-Principles of judicious use of antimicrobial agents. Pediatrics 1998;101(1 Suppl Pt 2):165-71.
- Stool SE, Berg AO, Berman S, et al. Otitis media with effusion in young children. Clinical practice guideline. AHCPR Publication no 94-0622 1994.
- American Academy of Family Physicians, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics Subcommittee on Otitis Media with Effusion. Otitis
media with effusion. Pediatrics 2004;113(5):1412-29.
|
|
|
| |
|
|
| |
| |
Date: August 16, 2006
Content source: National Center for Immunization and Respiratory Diseases / Division of Bacterial Diseases |
|
