Guidelines for Using Antibiotics in Children With Acute Otitis Media*
Age | Otorrhea | Severe symptoms† (unilateral or bilateral) | Bilateral disease | Unilateral disease, no severe symptoms |
|---|---|---|---|---|
< 6 months‡ | Antibiotics | Antibiotics | Antibiotics | Antibiotics |
6 months to 2 years | Antibiotics | Antibiotics | Antibiotics | Antibiotics or observe 48 to 72 hours§ |
≥ 2 years | Antibiotics | Antibiotics | Antibiotics or observe 48 to 72 hours§ | Antibiotics or observe 48 to 72 hours§ |
* These guidelines apply only to children who meet the diagnostic criteria for acute otitis media (eg, acute [within 48 hours] onset of pain, bulging of the tympanic membrane, and signs of middle ear effusion detected by pneumatic otoscopy). | ||||
† Symptoms include temperature ≥ 39° C rectally any time within previous 24 hours, moderate to severe otalgia for > 48 hours, or clinician’s judgment that child is seriously ill. | ||||
‡ The guidelines in the Pediatrics article from which this table was derived do not include this age group, in which observation has not been thoroughly studied. Thus, it is reasonable to continue to treat with antibiotics. | ||||
§ Decision making should be shared with parents. Observation is appropriate only if phone or office follow-up can be assured within 48 to 72 hours; antibiotics are started if no improvement. | ||||
Modified from Lieberthal AS, Carroll AE, Chonmaitree T, et al: The diagnosis and management of acute otitis media. Pediatrics e964–99, 2013. | ||||