Antimicrobial Therapy of Otitis Media Reduces the Incidence of Mastoiditis

Abstract

Otitis media is one of the most common infections of children and can rarely lead to bacteremia, meningitis, and mastoiditis [1]. Most episodes of acute otitis media in children are self-limiting and do not require antibiotic treatment. Although antibiotic use in the management of otitis media is routine in the United States, it is common practice in some countries in Europe to initially treat otitis media symptomatically and institute antimicrobial therapy only if clinical improvement does not occur. The implementation of the “watchful waiting” approach recommended by the American Academy of Pediatrics and American Academy of Family Physicians clinical practice guideline for the diagnosis and management of acute otitis media in 2004 [2] contributed to the reduction of antimicrobial use in the treatment of this infection. This option’s premise is that antibiotic treatment of some uncomplicated acute otitis media cases can be deferred if certain criteria are met, including diagnostic certainty and disease severity. The observation option was limited to children 6 months to 2 years of age who are otherwise healthy, with nonsevere illness at presentation, and an uncertain diagnosis, and to children 2 years of age and older with nonsevere symptoms at presentation and an uncertain diagnosis. One of the concerns that was voiced after the introduction of the “watchful waiting” approach was that it would cause an increase the rate of complications following otitis media.