Watchful waiting

Criteria for Initial Antibacterial-Agent Treatment or Observation in Children With AOM

Age	Certain Diagnosis	Uncertain Diagnosis
<6 mo	Antibacterial therapy	Antibacterial therapy
6 mo to 2 y	Antibacterial therapy	Antibacterial therapy if severe illness; observation option if nonsevere illness*
age 2 or greater	Antibacterial therapy if severe illness; observation option* if nonsevere illness	Observation option*

This table was modified with permission from the New York State Department of Health and the New York Region Otitis Project Committee.32,33

* Observation is an appropriate option only when follow-up can be ensured and antibacterial agents started if symptoms persist or worsen.

Nonsevere illness is mild otalgia and fever <39°C in the past 24 hours.
Severe illness is moderate to severe otalgia or fever greater than or equal to 39°C.
A certain diagnosis of AOM meets all 3 criteria: 1) rapid onset, 2) signs of MEE, and 3) signs and symptoms of middle-ear inflammation.

PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1451-1465

The following is from: Prescriber's Letter: May 2004; Vol: 11, No. 5

More physicians are holding off on antibiotics for kids' ear infections.
About 80% of otherwise healthy kids with acute otitis media get better without antibiotics.
The American Academy of Pediatrics and American Academy of Family Physicians now recommend "watchful waiting" for some kids.
They say to hold off antibiotics for 2 to 3 days to see if they're really necessary.
Watchful waiting is generally appropriate for children 2 years and older with mild symptoms.
It's NOT appropriate for babies under 6 months...or ANY child with moderate to severe pain or fever over 102˚F. These kids usually need antibiotics.
Have parents give acetaminophen or ibuprofen if needed for pain...whether or not the child is getting an antibiotic.