When should antibiotic therapy be initiated for treatment of acute otitis media (AOM)?

Updated: Sep 25, 2019
  • Author: John D Donaldson, MD, FRCSC, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

At present, a chorus of advocates recommends withholding antibiotic therapy for patients with AOM and following a “watchful waiting” or “wait and see” approach. As expected from long-known data, most children managed in this fashion do well, although a study from England observed an increase in the rate of mastoiditis in children that was, essentially, the inverse of the rate of decrease in prescriptions for acute otitis.

A literature review by Thomas et al, which included scrutiny of evidence-based AOM recommendations, particularly those found in current American guidelines, concluded that the data used to compare the usefulness of prompt antibiotic therapy with 2-3 days of watchful waiting are not completely consistent. The investigators stated that controlled trials with well-defined endpoints are still needed to better address the question. [21]


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