Antibiotics for acute otitis media
Abbas A. Anwar BS,Anil K. Lalwani MD
The Laryngoscope, Volume 122, Issue 1, pages 4–5, January 2012
Background
Acute otitis media (AOM) accounts for nearly 15 million antibiotic prescriptions every year and has become the most commonly cited reason for antimicrobial therapy among children in the United States
With the continuing rise of healthcare costs and the emergence of multi–drug-resistant bacteria, overuse of antibiotics has become a major public health concern worldwide
As a result, experts have called for the judicious use of antimicrobials in the treatment of AOM
However, despite years of clinical experience with the disease, an optimal treatment strategy is still unclear, as the clinical decision to treat or not to treat children with AOM remains controversial
Level of evidence
In this review, four level 1 studies (randomized controlled trials) and a national clinical guideline were reviewed
Best practice
- When medical therapy is deemed necessary for AOM, amoxicillin is considered the first-line treatment due to its safety, low cost, and narrow microbiologic spectrum
- In patients who have severe illness (moderate to severe otalgia or fever of 39°C or higher) amoxicillin-clavulanate should be used
- Currently, immediate antibiotic therapy is recommended in children younger than 6 months of age, whereas watchful waiting is advocated in children older than 6 months of age with non-severe illness
- However, two recent studies using more stringent diagnostic criteria for AOM have shown significantly better outcomes with immediate antibiotic therapy in children between 6 to 35 months of age
- These studies highlight the importance of accurate diagnosis of AOM in choosing therapeutic intervention, and its findings may lead to a re-evaluation of the watchful waiting strategy