Watchful Waiting in Pediatric Acute Otitis Media: A Real Practice Approach or an Intangible Desideratum?

Abstract

Acute otitis media (AOM) in children is one of the leading causes of health care visits and antibiotic prescriptions worldwide. The overall aim of the current study is twofold: 1. to analyze and discuss the antibiotic prescription patterns in AOM in children without complications or risk factors and 2. to assess to what extent the watchful-waiting approach is a real practice or a mere desideratum. We performed an electronic search in the PubMed and Embase databases from 2013 to 2023 to capture original research studies investigating antibiotic prescribing patterns for AOM in children. Among the 12 papers included in the analysis, the antibiotic prescription rate ranged from 44.8% to 98%. Our study reveals similarities regarding the use of amoxicillin as a first-line antibiotic in pediatric AOM, but also discrepancies in the watchful-waiting approach attitude and in the choice of second or third-line antimicrobial agents. The proportion of cases managed with the watchful-waiting approach ranged from 7.5% (Australia) to 55.2% (Finland). Denmark was the only country reporting penicillin V as a first-choice regimen for children with AOM, which fulfils the guidelines’ recommendations. The most unsatisfying rate of amoxicillin use was recorded in Japan, contrary to the recommendations of local guidelines. The use of quinolones was reported in two out of twelve studies, with the highest proportion in Japan, where tosufloxacin was used in 21.4% of the total number of cases. The duration of the antibiotic regimens was analyzed in three out of twelve papers. Since global antibiotic overuse contributes to the emergence of antibiotic resistant bacteria, new strategies are needed to increase the rate of watchful waiting and to promote the judicious use of antibiotics.

Proteomic Study of Middle Ear Effusion and Its Clinical Application for Otitis Media with Effusion

“…Although some guidelines have clearly pointed out that these two types of drugs should not be prescribed to patients with OME, 33 some patients, especially children, who still receive antibiotics and corticosteroids for treatment. 34 The results of our study suggest that some middle ear effusion proteins are related to inflammation, but the prominent portion is related to immunity, cell cycle, function and cell maintenance. Therefore, we hold the opinion that antibiotics should not be used for secretory otitis media treatment in the first place, which is consistent with the results of some previous study.…”

Atualidade Da Antibioticoterapia No Tratamento De Otite Média Aguda Em Crianças: Uma Revisão De Literatura

“…A despeito de alguns estudos (Dawit et al, 2021), nestes quadros, devido à experiência de mais de 25 anos, a amoxicilina tem se mantido como o fármaco de escolha para o tratamento de OMA em crianças (LE SAUX et al, 2016;KASPER et al, 2017;SPOIALÃ et al, 2021;FROST, 2022;EL FEGHALY, 2023;SPOIALÃ, 2023). A posologia é de 500mg a cada 12 horas ou 250mg a cada 8 horas (GOODMAN et al, 2011).…”

Watchful Waiting Strategy in the Treatment of Acute Otitis Media in Children

“…The watchful-waiting approach was mentioned in 9 of the 12 studies of large meta-analysis (13). The patients managed with watchful waiting ranged from 7.5% (14) to 55.2% (15).…”