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Review
. 2014 Feb 28;111(9):151-9; quiz 160.
doi: 10.3238/arztebl.2014.0151.

Acute otitis media--a structured approach

Jan Peter Thomas  1 , Reinhard Berner, Thomas Zahnert, Stefan Dazert
Affiliations
Review

Acute otitis media--a structured approach

Jan Peter Thomas et al. Dtsch Arztebl Int. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Dtsch Arztebl Int. 2016 Feb 19;113(7):113. doi: 10.3238/arztebl.2016.0107. Dtsch Arztebl Int. 2016. PMID: 26971366 Free PMC article. No abstract available.

Abstract

Background: Two-thirds of all children have an episode of acute otitis media (AOM) before their third birthday. Antibiotic treatment is often given immediately, even though adequate scientific evidence for this practice is lacking.

Method: This review is based on a selective literature search including previously published evidence-based recommendations, particularly those of the current American guidelines.

Results: A purulent tympanic effusion, possibly associated with inflammation of the tympanic membrane, is indicative of AOM. Only some patients with AOM need immediate antibiotic treatment: children with severe otalgia and/or fever of 39.0°C or above, infants under 6 months of age, and children with certain specific risk factors, including immune deficiency and Down syndrome. In other cases, symptomatic treatment is appropriate. Antibiotic therapy (preferably with amoxicillin) should be initiated only if the symptoms and signs do not improve within two to three days.

Conclusion: As the currently available data are not fully consistent, there is still a need for controlled trials with well-defined endpoints to determine the relative benefits of immediate antibiotic treatment versus two to three days of watchful waiting.

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Figures

Figure 1
Figure 1
Typical appearance of AOM (reproduced by kind permission of C.A. von Illberg)
Figure
Figure
Algorithm for treatment of acute otitis media (AOM)
See this image and copyright information in PMC

Comment in

  • Additions warranted.
    Aschendorff A, Maier W. Aschendorff A, et al. Dtsch Arztebl Int. 2014 Aug 4;111(31-32):545. doi: 10.3238/arztebl.2014.0545a. Dtsch Arztebl Int. 2014. PMID: 25145513 Free PMC article. No abstract available.
  • In reply.
    Peter Thomas J. Peter Thomas J. Dtsch Arztebl Int. 2014 Aug 4;111(31-32):545. doi: 10.3238/arztebl.2014.0545b. Dtsch Arztebl Int. 2014. PMID: 25145514 Free PMC article. No abstract available.

References

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