What not to do in acute otitis media: the top five recommendations proposed by the Italian Society of Preventive and Social Pediatrics

Abstract

Introduction: With the aim to reduce inappropriate procedures and antibiotic therapy in the

Acute Otitis Media in Childhood - Use of Guidelines for Diagnosis and Treatment in Emergency Rooms

“…All the guidelines emphasize the importance of well conducted otoscopy in the diagnosis of AOM. [10,24] In the present study, tympanic membrane bulging and the presence of a purulent effusion in the ear canal were the factors given most importance by the participants in diagnosing otitis. One of the principal diagnostic criteria proposed in the guidelines is that only the presence of otorrhoea or bilateral hyperaemia should be taken into consideratio.…”

“…Another option would be to increase the dose of amoxicillin and to use a second-generation cephalosporin such as cefuroxime or a third-generation cephalosporin such as ceftriaxone (50 mg/kg intramuscularly) in a 1-to 3-day treatment course. [10,41] In cases in which the patient fails to respond to the first-line treatment, the options used by the paediatricians in the present study were amoxicillin at double the standard dose (40.8%), amoxicillin at double the standard dose plus clavulanate (23.9%), and amoxicillin at the standard dose plus clavulanate (16.9%). The options used were considered adequate in the majority of cases and are in accordance with the guidelines.…”

“…[24,40] In children with persistent and severe symptoms of AOM and in cases in which there is no improvement following initial treatment, the clinician may consider changing the antibiotic. [10] Thus, if the child is initially treated with amoxicillin and fails to improve, amoxicillin plus clavulanate may be an option. Another option would be to increase the dose of amoxicillin and to use a second-generation cephalosporin such as cefuroxime or a third-generation cephalosporin such as ceftriaxone (50 mg/kg intramuscularly) in a 1-to 3-day treatment course.…”

“…Therefore, re-evaluation should be at the physician's discretion, taking into account the child's age, the intensity of symptoms, recurrence, or a request by the parents/caregivers. [10] Ideally, after commencing treatment with antibiotics, all children should be assessed with regards to clinical response, which is another area in which there is room for improvement in the management of otitis in Brazil.…”

“…This is a relevant factor in the inappropriate prescription of antibiotics, consequently leading to an increase in the occurrence of adverse events and in the development of bacterial resistance. [10][11][12] There is evidence that some physicians are resistant to complying with the diagnostic criteria proposed in standardized guidelines, suggesting that the information contained therein needs to be disseminated and its recommendations implemented to ensure the effective diagnosis and treatment of AOM, thus avoiding possible complications resulting from the infection. [13][14][15][16][17] The accurate diagnosis of AOM is a controversial subject in medical practice.…”