Pediatricians should carefully consider when to give children antibiotics for otitis media (OM), according to a new Pediatrics in Review article.
“Acute otitis media (AOM) is the most common bacterial illness in children,” according to the article Otitis Media: To Treat, To Refer, To Do Nothing: A Review for the Practitioner (Rosa-Olivares J, et al. Pediatr Rev. Nov. 2, 2015, http://pedsinreview.aappublications.org/content/36/11/480.full). While evidence shows antibiotics often are not indicated, they are prescribed frequently.
The article discusses the causes, types and treatments of OM and provides opportunities for continuing medical education credit.
“Otitis media and ear-related problems are so common that we felt it was worth it to refresh the memory of the providers,” said Jose Rosa-Olivares, M.D., lead author of the article and medical director of Nicklaus Children’s Hospital’s Pediatric Care Center.
The middle ear infection typically occurs between ages 6 and 24 months and is among the top reasons for visits to a pediatrician’s office and pediatric emergency department, according to the article. Risk factors include secondhand smoke exposure, preterm birth, bottle feeding, obesity and child care participation.
Children with AOM often have fever and ear pain. Other symptoms include sleep problems and irritability. Those with otitis media with effusion (OME) have fluid in the middle ear but do not have acute symptoms. OME also may cause conductive hearing loss. Experts agree that pneumatic otoscopy is the best tool to differentiate AOM from OME.
The authors also discuss when to use antibiotics and when to refer a patient to a specialist. Antibiotics tend to be overused for OM, and a watchful waiting approach may be appropriate depending on the child’s age and severity of symptoms, Dr. Rosa-Olivares said.
He referred pediatricians to the 2013 AAP clinical practice guideline The Diagnosis and Management of Acute Otitis Media (bit.ly/1GYXqCQ). He also stressed the need for communication between pediatricians and parents.
“It’s really about the relationship you adopt with your families, and when you have a good relationship … it makes your job easier as a primary care provider,” he said.
This month’s Pediatrics in Review also includes a related commentary Acute Otitis Media Perspectives in Israel, bit.ly/1NlNogt