Evidence Based Clinical Practice Guideline for medical management of Acute Otitis Media

• Assess risk factors and take history

Patient 2 mo to 13 yrs presents with signs
• Assess signs and symptoms
and symptoms suggestive of AOM
Requires excellent otoscopic skills and may require pneumatic
otoscope or tympanometry to enhance diagnostic accuracy.

Algorithm for evaluation and

management of AOM in
children 2 mo to 13 years of age High NO High
probability of probability
AOM? of OME?
Definition of AOM: NO
• history of acute
onset
YES YES NO
• presence of middle
ear effusion
• signs and symptoms Pain treatment
of middle ear as appropriate
Manage with Not guideline eligible:
inflammation CCHMC Evidence manage as appropriate.
Based Guideline for
OME
Age?

Less than 2 years of age 2 years of age or older

• Treat with 10 days of Well-appearing Severe illness

high dose amoxicillin**.
• Treat with a safety-net • Treat with 5 days of high
antibiotic prescription dose amoxicillin**.
(SNAP) to be filled after 48
-72 hours if symptoms do
**See text (page 4) and not resolve with observation
Appendix 3 for discussion of or sooner if symptoms
other antibiotic options, worsen (see SNAP
especially for recurrent AOM, definition below).
for child on recent antibiotic or
therapy for other reasons, or for • Treat with 5 days of high
allergies to penicillin. dose amoxicillin**.

• SNAP is a prescription for an Family Education • Start high dose

appropriate antibiotic, as 1. observational skills, amoxicillin** if not
determined by the when to follow-up if previously treated.
practitioner, written to be symptoms worsen Clinical • Change to
filled only within 5 days of 2. expectations for improvement NO amoxicillin/
the office visit. persistent MEE within 48 - clavulanate if child
• Instruct the parent not to fill 3. preventable risk factors 72 hrs? already on
SNAP unless symptoms for recurrence amoxicillin**.
worsen at any time or unless 4. relapse rate if • Refer or consult as
symptoms do not improve observation option appropriate, see text
YES
during a waiting period of 48 (page 5).
- 72 hours.
Reevaluate
• Instruct the parent that a well-
appearing child diagnosed in 4-8 weeks,
End depending
with AOM may quickly
progress to a more severe on existing
case, and to call and/or risk factors.
follow-up with practitioner if
this occurs.
Excerpted from: Evidence Based Clinical Practice Guideline for medical management of Acute Otitis Media
Publication date: 10-29-04