Acute Otitis Media Observation

Aka: Acute Otitis Media Observation, Observation Protocol for Acute Otitis Media Management

1. See Also
   1. Acute Otitis Media
   2. Acute Otitis Media Diagnosis
   3. Acute Otitis Media Management
   4. Acute Otitis Media Prevention
2. Background
   1. Most Otitis Media cases resolve without antibiotics
   2. Consider symptomatic treatment
   3. Antibiotics are more likely to cause side effects than speed symptomatic improvement
      1. Number Needed to Treat for one not to have Ear Pain at 2-7 days: 20
      2. Number Needed to Treat for one to have adverse antibiotic effects (Diarrhea, Vomiting, rash): 14
      3. (2013) Presc Lett 20(4): 20-21
3. Indications (with Informed Consent of parents)
   1. Age over 6 months without severe signs or symptoms (see below)
   2. Age over 2 years regardless of severity
4. Contraindications
   1. Age
      1. Under age 6 months
      2. Under age 2 years if severe signs or symptoms (see below)
   2. Recent antibiotics
      1. Three or more antibiotic courses in the current year
      2. Antibiotic course within the last 2 weeks
   3. Severe signs or symptoms (under age 2 years)
      1. Moderate or severe Otalgia (especially if up keeping awake at night)
      2. Otalgia >48 hours
      3. Fever >102.2 F (39 C)
      4. Bilateral Otitis Media (under age 2 years)
   4. Associated Findings
      1. Ear discharge (Otorrhea)
      2. Chronic Suppurative Otitis Media
      3. Vomiting (part of original criteria to exclude observation)
5. Protocol
   1. Treat symptomatically for 3 days (see Otalgia for pain management)
   2. By day 3, outcomes same with or without antibiotics
      1. Distress: 19% (15% with antibiotics)
      2. Sleep disturbed 27% (20% with antibiotics)
   3. If still symptomatic at day 3
      1. Start antibiotics
6. Efficacy
   1. Placebo: 81% of infections resolve within 1 week
   2. Antibiotics: 94% of infections resolve within 1 week
   3. Outcomes
      1. Middle ear fluid same at 3 months
      2. Mastoiditis
         1. Without antibiotics: 4 per 100,000 children/year
         2. With antibiotics: 2 per 100,000 children per year
7. References
   1. Harmes (2013) Am Fam Physician 88(7): 435-40 [PubMed]
   2. Hendley (2002) N Engl J Med 345: 1169 [PubMed]
   3. Little (2002) BMJ 325:22-5 [PubMed]