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Acute Otitis Media Observation
Aka: Acute Otitis Media Observation, Observation Protocol for Acute Otitis Media Management
- See Also
- Acute Otitis Media
- Acute Otitis Media Diagnosis
- Acute Otitis Media Management
- Acute Otitis Media Prevention
- 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
- Indications (with Informed Consent of parents)
- Age over 6 months without severe signs or symptoms (see below)
- Age over 2 years regardless of severity
- 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)
- 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
- 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
- References
- Harmes (2013) Am Fam Physician 88(7): 435-40 [PubMed]
- Hendley (2002) N Engl J Med 345: 1169 [PubMed]
- Little (2002) BMJ 325:22-5 [PubMed]