Choosing Wisely:

Don’t prescribe antibiotics for otitis media in children aged two to 12 years with nonsevere symptoms where the observation option is reasonable.

Rationale and Comments: The “observation option” refers to deferring antibacterial treatment of selected children for 48 to 72 hours and limiting management to symptomatic relief. The decision to observe or treat is based on the child’s age, diagnostic certainty and illness severity. To observe a child without initial antibacterial therapy, it is important that the parent or caregiver has a ready means of communicating with the clinician. There also must be a system in place that permits reevaluation of the child.
Sponsoring Organizations:
  • American Academy of Family Physicians
  • Sources:
  • American Academy of Pediatrics guidelines
  • Disciplines:
  • Otolaryngologic
  • Infectious disease
  • Pediatric
  • References: • Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, Joffe MD, Miller DT, Rosenfeld RM, Sevilla XD, Schwartz RH, Thomas PA, Tunkel DE, American Academy of Pediatrics. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-99.
    • Venekamp RP, Sanders S, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2013 Jan 31;1:CD000219.

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