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The Clinical Guideline Committee is looking for interested members to help review published guidelines and determine applicability to urgent care.

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Home >Clinical Practice Pediatric Otitis

Urgent Care Focused Guideline Highlights

Diagnosis and Management of Acute Otitis Media

The following is a highlight of a guideline from another group reviewed by Urgent Care physicians. Our intent is to assure these highlights represent the actual intent of these articles and how they relates to the practice of urgent care medicine. These highlights are not intended to substitute for independent medical judgement nor are they intended to establish a standard of care. UCCOP recommends at minimum reading those portions of this article that relate to the scope of care you provide. 

Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media
Published March 2013

Synopsis by Tracey Davidoff, MD and Sean McNeeley, MD

Lieberthal, AS, Carroll AE, Chonmaitree, T, et. al. Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media, Pediatrics 2013;131:e964-e999. Full article can be found here.

Please note that strength of recommendation, quality of evidence is listed in parenthesis for each recommendation.  The rating of these guidelines follows the GRADE system.  More information about GRADE can be found here.

1A. Acute otitis media (AOM) should be diagnosed in children who present with moderate to severe bulging of the tympanic membrane (TM) or new onset of otorrhea not due to acute otitis externa. (Grade B, recommendation)

1B. Acute otitis media may be diagnosed in children who present with mild bulging of the TM and recent (<48hours) of ear pain (holding, tugging, rubbing in non-verbal child) or intense erythema of the TM. (Grade C, recommendation)

1C. Acute otitis media should NOT be diagnosed in children who do not have a middle ear effusion (MEE). (Grade B, recommendation)

2. The management of AOM should include the assessment and treatment of pain. (Grade B, strong recommendation)

3A. Severe AOM: The clinician should prescribe antibiotics for AOM, bilateral or unilateral in children 6 months and older with severe signs and symptoms (moderate to severe pain for at least 48 hours or temperature >39°C) (Grade B, strong recommendation)

3B. Non-severe bilateral AOM in young children: The clinician should prescribe antibiotics for bilateral AOM in children 6 – 23 months without severe signs or symptoms.  (Grade B, recommendation)

3C. Non-severe unilateral AOM in young children:  The clinician should either prescribe antibiotics or offer observation with close follow-up based on joint decision making with the parent or caregiver for unilateral AOM in children 6 – 23 months without severe signs or symptoms (i.e. mild otalgia for < 48 hours and temperature <39°C). A mechanism must be in place to ensure follow-up and begin antibiotics if the child worsens in 48-72 hours. (Grade B, recommendation)

3D. Non-severe AOM in older children: The clinician should either prescribe antibiotics or offer observation with close follow-up based on joint decision making with parent or caregiver for AOM (bilateral or unilateral) in children >24 months without severe signs and symptoms (i.e. mild otalgia for <48 hours and temperature less than 39°C).  A mechanism must be in place to ensure follow-up and begin antibiotics if the child worsens in 48-72 hours. (Grade B, recommendation)

4A. The antibiotic of choice for AOM is amoxicillin if the child has not received amoxicillin in the past 30 days or the child does not have concurrent purulent conjunctivitis or the child is not allergic to penicillin. (Grade C, recommendation)

4B.  Clinicians should prescribe an antibiotic with additional β-lactamase coverage if the patient has received amoxicillin in the last 30 days or has concurrent purulent conjunctivitis or has a history of recurrent AOM unresponsive to amoxicillin. (Grade C, recommendation)

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