AAP Guideline Revisions for Acute Otitis Media

The American Academy of Pediatrics (AAP) recently published revisions to the 2004 acute otitis media guidelines in the March issue of Pediatrics. These guidelines provide recommendations for the management of uncomplicated acute otitis media in otherwise healthy children from 6 months through 12 years of age without tympanostomy tubes, anatomic abnormalities such as cleft palate or Down syndrome, immune deficiencies, or cochlear implants.

The 2004 guidelines used a three-part definition for acute otitis media: acute onset of symptoms, acute middle ear inflammation, and middle ear effusion. The 2013 update also requires middle ear effusion for diagnosis, but it now has to be based on tympnometry or pneumatic otoscopy. Additional diagnostic criteria include: moderate to severe bulging of the tympanic membrane or new onset of discharge not due to an infected ear canal, and mild bulging of the ear drum and onset of ear pain within 48 hours, which could be indicated by holding, tugging, rubbing of the ear for nonverbal children, or intense redness of the tympanic membrane.

Other 2013 revisions include:

·         Antibiotics should be given for severe cases of bilateral or unilateral acute otitis media for children >6 months based on ear pain that is moderate or severe, lasts for at least 48 hours, or is accompanied by a temperature of >102.2°F.

·         In less severe cases, watchful waiting could be offered instead of antibiotics unless both ears are affected in kids aged 6–23 months.

·         Recurrent acute otitis media is defined as three episodes in six months or four episodes in the prior year with one in the past six months.

·         Prophylactic antibiotics should not be prescribed to reduce recurrences. Instead, these children may be offered the option of tympanostomy tubes.

·         Amoxicillin remains the first-line agent; drugs that have additional beta-lactamase coverage are selected for kids who have already had it in the prior month or who are allergic to penicillin

·         Pneumococcal conjugate vaccine and annual flu shots are recommended for all children

For more information call (800) 433-9016 or visit www.aap.org