A definition of the recommendations rating scheme is provided at the end of the "Major Recommendations" field.
Recommendation 1: To diagnose acute otitis media (AOM), the clinician should confirm a history of acute onset, identify signs of middle-ear effusion, and evaluate for the presence of signs and symptoms of middle-ear inflammation. (Recommendation) (See Table 2 in the original guideline document.)
Recommendation 2: The management of AOM should include an assessment of pain. If pain is present, the clinician should recommend treatment to reduce pain. (Strong Recommendation)
Recommendation 3A: Observation without use of antibacterial agents in a child with uncomplicated AOM is an option for selected children based on diagnostic certainty, age, illness severity, and assurance of follow-up. (Option)
Recommendation 3B: If a decision is made to treat with an antibacterial agent, the clinician should prescribe amoxicillin for most children. (Recommendation) When amoxicillin is used, the dose should be 80 to 90 mg/kg/day. (Option)
Recommendation 4: If the patient fails to respond to the initial management option within 48 to 72 hours, the clinician must reassess the patient to confirm AOM and exclude other causes of illness. If AOM is confirmed in the patient initially managed with observation, the clinician should begin antibacterial therapy. If the patient was initially managed with an antibacterial agent(s), the clinician should change the antibacterial agent(s). (Recommendation)
Recommendation 5: Clinicians should encourage the prevention of AOM through reduction of risk factors. (Recommendation)
Recommendation 6: There is insufficient evidence to make a recommendation regarding the use of complementary and alternative medicine (CAM) for AOM. (No Recommendation)
Definitions:
Strong Recommendation
A strong recommendation in favor of a particular action is made when the anticipated benefits of the recommended intervention clearly exceed the harms (as a strong recommendation against an action is made when the anticipated harms clearly exceed the benefits) and the quality of the supporting evidence is excellent. In some clearly identified circumstances, strong recommendations may be made when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms. Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.
Recommendation
A recommendation in favor of a particular action is made when the anticipated benefits exceed the harms, but the quality of evidence is not as strong. Again, in some clearly identified circumstances, recommendations may be made when high-quality evidence is impossible to obtain but the anticipated benefits outweigh the harms. Clinicians would be prudent to follow a recommendation, but should remain alert to new information and sensitive to patient preferences.
Option
Options define courses that may be taken when either the quality of evidence is suspect or carefully performed studies have shown little clear advantage to one approach over another. Clinicians should consider the option in their decision making, and patient preference may have a substantial role.
No Recommendation
No recommendation indicates that there is a lack of pertinent published evidence and that the anticipated balance of benefits and harms is presently unclear. Clinicians should be alert to new published evidence that clarifies the balance of benefit versus harm.
