Acute otitis media in children 6 months to 2 years of age.

QUESTION: Acute otitis media (AOM) is one of the most common findings among children in our family medicine office, and we frequently see this illness during seasons with high rates of upper respiratory tract infections. With more widespread pneumococcal immunization, has the rate of AOM declined? What are the current recommendations for antibiotic treatment?

ANSWER: Although rates of the infection have declined over time with better uptake of vaccines against Streptococcus pneumoniae, AOM is still prevalent in the pediatric population and may be associated with serious complications that affect hearing and quality of life. Once a diagnosis has been made (based on a combination of acute onset of symptoms, signs of middle ear inflammation, and effusion), treatment of children 6 months to 2 years of age depends on physical examination findings. Children with perforated tympanic membranes and purulent discharge should receive 10 days of systemic antibiotics. For children with more mild symptoms or early AOM, primary care providers should consider either treatment or watchful waiting.