American Academy of Pediatrics

TABLE 4

Recommendations for Initial Management for Uncomplicated AOM^a

Age	Otorrhea With AOM^a	Unilateral or Bilateral AOM^a With Severe Symptoms^b	Bilateral AOM^a Without Otorrhea	Unilateral AOM^a Without Otorrhea
6 mo to 2 y	Antibiotic therapy	Antibiotic therapy	Antibiotic therapy	Antibiotic therapy or additional observation
≥2 y	Antibiotic therapy	Antibiotic therapy	Antibiotic therapy or additional observation	Antibiotic therapy or additional observation^c

Age	Otorrhea With AOM^a	Unilateral or Bilateral AOM^a With Severe Symptoms^b	Bilateral AOM^a Without Otorrhea	Unilateral AOM^a Without Otorrhea
6 mo to 2 y	Antibiotic therapy	Antibiotic therapy	Antibiotic therapy	Antibiotic therapy or additional observation
≥2 y	Antibiotic therapy	Antibiotic therapy	Antibiotic therapy or additional observation	Antibiotic therapy or additional observation^c

Applies only to children with well-documented AOM with high certainty of diagnosis (see Diagnosis section).

A toxic-appearing child, persistent otalgia more than 48 h, temperature ≥39°C (102.2°F) in the past 48 h, or if there is uncertain access to follow-up after the visit.

This plan of initial management provides an opportunity for shared decision-making with the child’s family for those categories appropriate for additional observation. If observation is offered, a mechanism must be in place to ensure follow-up and begin antibiotics if the child worsens or fails to improve within 48 to 72 h of AOM onset.

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