II. Background
- Most Otitis Media cases resolve without Antibiotics
- Consider symptomatic treatment
-
Antibiotics are more likely to cause side effects than speed symptomatic improvement
- Number Needed to Treat for one not to have Ear Pain at 2-7 days: 20
- Number Needed to Treat for one to have adverse Antibiotic effects (Diarrhea, Vomiting, rash): 14
- (2013) Presc Lett 20(4): 20-21
III. Indications (with Informed Consent of parents)
- Age over 6 months without severe signs or symptoms (see below)
- Age over 2 years regardless of severity
IV. Contraindications
- Age
- Under age 6 months
- Under age 2 years if severe signs or symptoms (see below)
- Recent Antibiotics
- Three or more Antibiotic courses in the current year
- Antibiotic course within the last 2 weeks
- Severe signs or symptoms (under age 2 years)
- Moderate or severe Otalgia (especially if up keeping awake at night)
- Otalgia >48 hours
- Fever >102.2 F (39 C)
- Bilateral Otitis Media (under age 2 years)
- Associated Findings
- Ear discharge (Otorrhea)
- Chronic Suppurative Otitis Media
- Vomiting (part of original criteria to exclude observation)
V. Protocol
- Treat symptomatically for 3 days (see Otalgia for pain management)
- By day 3, outcomes same with or without Antibiotics
- Distress: 19% (15% with Antibiotics)
- Sleep disturbed 27% (20% with Antibiotics)
- If still symptomatic at day 3
- Start Antibiotics
VI. Efficacy
- Placebo: 81% of infections resolve within 1 week
- Antibiotics: 94% of infections resolve within 1 week
- Outcomes
- Middle ear fluid same at 3 months
- Mastoiditis
- Without Antibiotics: 4 per 100,000 children/year
- With Antibiotics: 2 per 100,000 children per year