Always use pneumatic otoscopy or tympanometry to confirm middle ear effusion
| Signs or symptoms of AOM-including ear pain, fever, and bulging yellow or red TM |
| If yes... | If no... |
| AOM
Presence of effusion (always use pneumatic otoscopy or tympanometry) with signs or symptoms of acute infection (ear pain, fever, or bulging yellow or red TM).
Treatment
Choose narrow spectrum drugs first.
Amoxicillin, especially at high doses (80-90 mg/kg/day)5, remains highly effective and is recommended as the first-line antibiotic by most experts.2, 3, 4 | OME
Presence of effusion (including immobility of the tympanic membrane) without signs or symptoms of acute infection. Nonspecific signs and symptoms (rhinitis, cough, diarrhea) are often present.
Treatment
Antibiotics are not required for initial treatment.5
Meta-analysis of all known studies showed only marginal short term benefit, and no long term benefit (greater than one month) of antibiotic treatment. |
Only consider antibiotic prophalaxis for recurrent AOM as defined by greater than three distinct, well-documented episodes in six months (or greater than four in 12 months).
Residual effusion after AOM normally persists for up to six weeks - no evidence of benefit from treatment in these cases. | Share this algorithm with parents. Explain when the risks of using antibiotics outweigh the benefits.
Avoiding unnecessary treatment of OME would save up to 6-8 million courses of antibiotics each year.5 |
References
- Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz B. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics 1998;101:165-171.
- McCracken GH. Considerations in selecting an antibiotic for treatment of acute otitis media. Pediatr Infect Dis J. 1994;13:1054-1057.
- Barnett ED, Klein JO. The problem of resistant bacteria for the management of acute otitis media. Ped Clin N America 1995;42:509-17.
- Dowell SF, Butler JC, Giebink GS. Acute otitis media: management and surveillance in an era of pnemococcal resistance-a report from Drug-resistance Streptococcus pneumoniae Therapeutic Working Group. Pediatr Infect Dis J 1999;18:1-9.
- Stool SE, Berg AO, Berman S, et al. Otitis media with effusion in young children. Clinical practice guideline. AHCPR Publication no 94-0622 1994.
- Williams RL, Chalmers TC, Stange KC, Chalmers FT, Bowlin SJ. Use of antibiotics in preventing recurrent acute otitis media and in treating otitis media with effusion. A meta-analytic attempt to resolve the brouhaha. JAMA 1993;270:1344-51.