Otitis media: immediate antibiotics or watchful waiting?

Abstract

Immediate antibiotic treatment for children with acute otitis media (AOM) has been shown to improve symptoms, although failure, relapse and recurrence are common following antibiotic treatment. Until recently, almost all children in the USA received antibiotics for the immediate management of AOM. However, widespread use of antibiotics for AOM has led to the emergence of multidrug-resistant bacteria. Studies indicate that antibiotic prescribing for AOM can be reduced in children with nonsevere AOM by as much as 50% without serious harmful consequences, because symptoms can be effectively controlled in such children with analgesic medication alone. Substantial data now exist, and guidelines support, the use of watchful waiting or a wait-and-see prescription for selected children with AOM. This paper will summarize the reasons why watchful waiting may be an appropriate alternative treatment for selected children with AOM. We will also describe a simple screening method that can facilitate clinical decision making.