Otitis media: Review of the 2004 treatment guidelines

OBJECTIVE: To review the 2004 treatment guidelines provided by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) regarding the treatment of otitis media in pediatric patients. DATA SOURCES: A MEDLINE search, restricted to English-language articles about pediatric patients, was conducted (1966-May 2005) using the key words acute otitis media (AOM), guideline, observation therapy, and vaccination. Additional references were located through review of the bibliographies of cited articles. STUDY SELECTION AND DATA EXTRACTION: Studies related to the fundamental basis of the updated guidelines and articles addressing current issues related to otitis media infection were included. DATA SYNTHESIS: Otitis media affects many children in the US. Concerns have been raised about the proper treatment of AOM in the face of increasing drug resistance among primary pathogens responsible for infection. Some countries have chosen to observe patients for a designated period of time prior to initiation of antibiotic therapy. The AAP and AAFP have updated the treatment guidelines for otitis media to include the option of observation therapy, recommendations for dosing of various antibiotic regimens and their place in therapy, and the importance of initial pain management. CONCLUSIONS: Updated treatment guidelines for otitis media have been developed in an effort to properly treat children while decreasing current resistance rates for common organisms that cause AOM. In the future, the therapeutic outcomes of observation therapy related to both the incidence of drug resistance and the possibility of increased complications related to otitis media will need to be evaluated in the US.