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AAP revises AOM diagnosis, treatment guidelines
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Updated guidelines for acute otitis media diagnosis and management emphasize tympanic membrane bulging and other factors.
Allan S. Lieberthal, MD, and colleagues of the AAP’s Subcommittee in Diagnosis and Management of Acute Otitis Media joined with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to create the new guidelines.
Allan S. Lieberthal
Lieberthal and colleagues suggested a narrower diagnosis of AOM that focuses on children with moderate-to-severe bulging of the tympanic membrane accompanied by middle ear effusion. They also said to consider AOM in those children with new onset of otorrhea unrelated to acute otitis externa.
The guidelines also state that mild bulging of the tympanic membrane and ear pain lasting less than 48 hours or intense erythema may warrant a diagnosis.
Regarding treatment, the guidelines recommend that antibiotics should be given to children aged younger than 24 months who have bilateral AOM or who do not have severe symptoms and also to those children aged older than 6 months with unilateral or bilateral AOM who experience severe symptoms. The guidelines note that observation may be a consideration in those children with nonsevere unilateral cases.
Lieberthal and colleagues said high-dose amoxicillin is the preferred choice for treatment, provided that the child has not taken the drug in the past 30 days, is not allergic to penicillin, and does not have concurrent purulent conjunctivitis. If any of these prevent the child from being prescribed amoxicillin, clinicians should prescribe an antibiotic with additional beta-lactamase coverage.
“The new guideline should decrease over-diagnosis of AOM and use of antibiotics when they are not needed. Overuse of antibiotics leads to increased bacterial resistance. Antibiotics also have significant side effects for the child,” Lieberthal told Infectious Diseases in Children.
Disclosure: Lieberthal reports no relevant financial disclosures.
Allan S. Lieberthal, MD,can be reached at ALieberthal@aap.net.
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