What are the AAP treatment guidelines for 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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AAP management-related action statements include the following [38, 39] :

  • AOM management should include pain evaluation and treatment

  • Antibiotics should be prescribed for bilateral or unilateral AOM in children aged at least 6 months with severe signs or symptoms (moderate or severe otalgia or otalgia for 48 hours or longer or temperature 39°C or higher) and for nonsevere, bilateral AOM in children aged 6-23 months

  • On the basis of joint decision-making with the parents, unilateral, nonsevere AOM in children aged 6 -23 months or nonsevere AOM in older children may be managed either with antibiotics or with close follow-up and withholding of antibiotics unless the child worsens or does not improve within 48-72 hours of symptom onset

  • Amoxicillin is the antibiotic of choice unless the child received it within the previous 30 days, has concurrent purulent conjunctivitis, or is allergic to penicillin; in these cases, clinicians should prescribe an antibiotic with additional β-lactamase coverage

  • Clinicians should reevaluate a child whose symptoms have worsened or not responded to the initial antibiotic treatment within 48-72 hours and change treatment if indicated

  • In children with recurrent AOM, tympanostomy tubes, but not prophylactic antibiotics, may be indicated to reduce the frequency of AOM episodes

  • Clinicians should recommend pneumococcal conjugate vaccine and annual influenza vaccine to all children according to updated schedules

  • Clinicians should encourage exclusive breastfeeding for 6 months or longer

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