Up to 83% of children with have AOM at least once by their 3rd birthday.
In 2006, the AAP supported a “wait-and-see” plan for antibiotic prescription
Who can you withhold abx on?
Older than 6months
No severe infections (T>39°C)
If yes to both, may hold Abx for 48 hours.
This approach does not mean “No treatment.” Pain management is imperative.
Oral Analgesics are recommended in all cases.
Topical aqueous 2% licocaine eardrops also provide Rapid Pain Relief
Randomized, double-blinded, placebo-control study of topical lidocaine vs. placebo (water) demonstrated decreased pain scores at 10, 20, and 30 minutes after administration.
These can also be used safely at home for a few days.
References
Spiro, D. Tay, K. Wait-to-see prescription for the treatment of acute otitis media. JAMA 2006, 1235.
Bolt, P., Barnett, P., Babl, F., Sharwood, L. Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Arch Dis Child. 2008; 93: 40-44.
