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The concept and practice of a wait-and-see approach to acute otitis media
David M Spiro1, Donald H Arnold
1Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon 97239, USA. spirod@ohsu.edu
Insights
For acute otitis media in children, a wait-and-see approach, alongside symptomatic care, can reduce antibiotic use and adverse events. Immediate antibiotics are reserved for specific indications, improving antimicrobial stewardship.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Acute otitis media (AOM) is a common pediatric infection.
- Antibiotic overuse contributes to antimicrobial resistance.
Purpose of the Study:
- Review current AOM management strategies.
- Evaluate the wait-and-see approach versus immediate antibiotic therapy.
- Provide guidance on antibiotic indications for AOM.
Main Methods:
- Literature review of contemporary AOM management.
- Analysis of evidence for symptomatic care, observation, and immediate antibiotic use.
- Synthesis of current guidelines and recent trial data.
Main Results:
- Selective observation is recommended for AOM in children.
- Wait-and-see approach reduces antibiotic use and adverse events.
- Analgesics may provide similar pain relief to antibiotics for AOM.
Conclusions:
- Antibiotics offer marginal benefit for most pediatric AOM cases.
- A proposed algorithm incorporates a wait-and-see strategy with clear antibiotic indications.
- Shared decision-making empowers families and promotes antimicrobial stewardship.
Purpose Of Review:
We review the contemporary management of acute otitis media, including symptomatic care, the rationale and literature for utilizing the wait-and-see approach, and the indications for immediate therapy with antibiotics.
Recent Findings:
Current guidelines recommend selective use of observation in children diagnosed with acute otitis media. Recent evidence suggests that a wait-and-see approach will reduce the use of antibiotics and decrease adverse events associated with their use. Earlier studies found that antimicrobials reduce pain and discomfort in the acute phase of illness compared with placebo. A recently published trial, however, suggests that when analgesics are utilized there may be minimal or no difference in otalgia whether antibiotics are prescribed or withheld.
Summary:
Treatment of acute otitis media is the most frequent indication for prescribing antibiotics in the pediatric population. Evidence suggests there is marginal benefit from antibiotics for most children diagnosed with AOM. Based on current data, we propose an algorithm for the management of children with AOM that includes a wait-and-see approach with specific indications for immediate treatment with antibiotics. A wait-and-see approach to acute otitis media that empowers families by using a shared decision-making model will reduce the use of antibiotics and will decrease resistance to antimicrobials.
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