[Policy Statement] New guidelines for pediatric acute otitis media released
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Image: PD
In a released statement:
1. The American Academy of Pediatrics (AAP) has updated recommendations for diagnosis and treatment of acute otitis media (AOM) for children 6 months through 12 years of age.
2. The statement highlights the importance of tympanic membrane (TM) visualization in diagnosis, provides guidelines for antibiotic use, and recommendations for AOM prevention.
In an update to their 2004 guidelines, the AAP offers discrete diagnostic criteria and treatment options for uncomplicated AOM in otherwise healthy children. Specifically, the new guidelines were issued to incorporate growing evidence on visualization of the TM in diagnosis, treatment options, and protective effects of the pneumococcal vaccine. A diagnosis of AOM should be made in any of four ways: (1) new-onset otorrhea not due to otitis externa, or on TM visualization, (2) moderate or severe bulging, (3) mild bulging accompanied by less than 48 hours of ear pain, or (4) intense erythema. Bilateral AOM in young children (6 months – 23 months), even without severe symptoms, warrants antibiotics. Children older than 6 months should only be prescribed antibiotics for severe symptoms like otalgia lasting longer than 48 hours or a temperature higher than 39°C. In all children with non-severe symptoms, joint decision-making with the parent or caregiver is preferred with regards to immediate treatment or observation; appropriate follow-up should be in place for observation.
Analgesic treatment is indicated for symptomatic relief. When indicated, the first-line antibiotic recommended is amoxicillin alone; if the patient has used it in the last 30 days or has concurrent purulent conjunctivitis, clavulanate (a beta-lactamase inhibitor) should be added to increase efficacy. An allergy to amoxicillin warrants cephalosporin prescription instead. Antibiotic choice should be reassessed if there is no improvement in 48 – 72 hours.
Antibiotic prophylaxis for recurrent AOM is not recommended, though tympanostomy tubes may be considered. Prevention of AOM includes pneumococcal and annual influenza vaccination, exclusive breastfeeding for at least the first 6 months of life, and avoidance of tobacco exposure.
Click to read the guidelines in Pediatrics
By Neha Joshi and Devika BhushanÂ
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