Stronger criteria for diagnosing otitis media

The American Academy of Pediatrics (AAP) has issued a revised clinical practice guideline for the diagnosis and management of uncomplicated acute otitis media (AOM) in children aged 6 months to 12 years.

The evidence-based guideline, significantly revised and updated since originally published in 2004 and subjected to comprehensive peer review before its final approval, provides stricter diagnostic criteria for AOM based on pneumatic otoscopy findings and encourages broader use of watchful waiting before initiating antibiotics.

The guideline identifies degrees of presentation and makes recommendations for pain management, observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures, all on the basis of a child’s age and severity of symptoms. It also addresses recurrent AOM that was not included in the original guideline by discouraging the prescribing of prophylactic antibiotics to reduce the frequency of recurrent AOM and suggesting the option of tympanostomy tubes in these cases.

Other recommendations advise physicians to promote pneumococcal conjugate vaccine and annual influenza vaccine for all children to help prevent upper respiratory infections that may lead to AOM; exclusive breastfeeding of infants for at least 6 months and avoiding pacifiers to reduce episodes of AOM in infancy; and lifestyle changes such as eliminating children’s exposure to passive tobacco smoke.

The AAP says the guideline is intended to assist primary care clinicians, including pediatricians, family practitioners, emergency department physicians, otolaryngologists, physician assistants, and nurse practitioners, with the accurate diagnosis and initial treatment of a child presenting with AOM and is not meant to establish protocol, be a sole source of guidance, or replace clinical judgment.