Clinical Evidence Handbook

A Publication of BMJ Publishing Group

Acute Otitis Media in Children

 

Am Fam Physician. 2017 Jan 15;95(2):109-110.

Author disclosure: Roderick P. Venekamp and Roger A.M.J. Damoiseaux are authors of references cited in this review. Anne G.M. Schilder's institute has received a grant from GlaxoSmithKline for a study on the microbiology of acute tympanostomy tube otorrhea.

Acute otitis media (AOM) is characterized by the presence of middle ear effusion together with an acute onset of signs and symptoms caused by middle ear inflammation.

  • The most common pathogens in AOM are Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis. Local resistance patterns are important when choosing the type of antibiotic.

  • In the United Kingdom, antibiotics are prescribed for about 87% of AOM episodes in children's primary care visits.

  • Without antibiotics, the clinical symptoms of AOM resolve in about 80% of children within three days.

Analgesics (paracetamol, nonsteroidal anti-inflammatory drugs, and topical anesthetic ear drops) may reduce earache compared with placebo.

Antibiotics seem to reduce pain at two to seven days compared with placebo, but they increase the risks of vomiting, diarrhea, and rash.

We do not know whether any one antibiotic regimen should be used in preference to another, although amoxicillin may be more effective than macrolides and cephalosporin.

Immediate antibiotic use seems most beneficial in children younger than two years with bilateral AOM and in children who have AOM with ear discharge.

  • Immediate antibiotic treatment may provide short-term reduction for some symptoms of AOM, but it increases the risks of rash and diarrhea compared with delayed treatment.

Longer courses of antibiotics reduce short-term treatment failure but have no benefit in the longer term compared with shorter regimens (seven days or less).

Myringotomy may be less effective than antibiotics at reducing symptoms, and we found no evidence that it is superior to no myringotomy.

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Clinical Questions

What are the effects of treatments (analgesics, antibiotics, and myringotomy) in children with acute otitis media?

Likely to be beneficial

Analgesics (paracetamol, nonsteroidal anti-inflammatory drugs, topical anesthetic ear drops)

Trade-off between benefits and harms

Antibiotics (reduce symptoms more quickly than placebo but increase adverse effects)

Choice of antibiotic regimen

Immediate compared with delayed antibiotic treatment

Longer vs. shorter courses of antibiotics (reduce treatment failure in the short term but not the long term)

Likely to be ineffective or harmful

Myringotomy

Clinical Questions

What are the effects of treatments (analgesics, antibiotics, and myringotomy) in children with acute otitis media?

Likely to be beneficial

Analgesics (paracetamol, nonsteroidal anti-inflammatory drugs, topical anesthetic ear drops)

Trade-off between benefits and harms

Antibiotics (reduce symptoms more quickly than placebo but increase adverse effects)

Choice of antibiotic regimen

Immediate compared with delayed antibiotic treatment

Longer vs.

Author disclosure: Roderick P. Venekamp and Roger A.M.J. Damoiseaux are authors of references cited in this review. Anne G.M. Schilder's institute has received a grant from GlaxoSmithKline for a study on the microbiology of acute tympanostomy tube otorrhea.

This is one in a series of chapters excerpted from the Clinical Evidence Handbook, published by the BMJ Publishing Group, London, U.K. The medical information contained herein is the most accurate available at the date of publication. More updated and comprehensive information on this topic may be available in future print editions of the Clinical Evidence Handbook, as well as online at http://www.clinicalevidence.bmj.com (subscription required).

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.

A collection of Clinical Evidence Handbook published in AFP is available at https://www.aafp.org/afp/bmj.

 

 

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