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Watchful Waiting for Uncomplicated Acute Otitis Media: Is It Actually Happening?

June 24, 2022

In 2013, the American Academy of Pediatrics (AAP) revised the 2004 guidelines on treatment of acute otitis media (AOM) to emphasize that most uncomplicated AOM infections in children over a year of age should be handled by observation for 2-3 days before prescribing antibiotics, an evidence-based approach known as “watchful waiting”. (10.1542/peds.2012-3488). Since the publication of that AAP policy, have we practiced what the guideline preaches?

To answer that question, Smolinski et al from the University of Florida (10.1542/peds.2021-055613) share with us an analysis of commercially insured children from 2005 to 2019. Of the more than 2.1 million AOM episodes, most (77.8%) were treated without watchful waiting. 

The lack of watchful waiting seemed to be driven primarily by clinician, not parent factors. These included the specialty of that physician and overall prescribing tendency, suggesting that routine antibiotic treatment is a habit. (Those who were less likely to usually prescribe antibiotics used watchful waiting >80% of the time. Interestingly, otolaryngologists were significantly more likely to adopt watchful waiting than pediatricians, and other non-pediatric specialties prescribed antibiotics even more than pediatricians. Link to this study for far more than an earful of findings that will hopefully make you even more of a watchful waiter than you are today.

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