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Acute Otitis Media Observation
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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]
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