Otitis media - principles of judicious use of antimicrobial agents

Because antibiotics are more frequently prescribed for otitis media than any other condition in the US, eliminating unnecessary treatment may profoundly reduce antibiotic use. Ear infections can be classified as episodes of acute otitis media (AOM), requiring antibiotic treatment, or otitis media with effusion (OME), with medication not indicated if persisting less than three months. The diagnosis of AOM must include documented evidence of fluid in the middle ear as well as symptoms of local or systemic illness. OME is the presence of fluid in the middle ear with no acute symptoms.
Otitis media is the leading indication for outpatient antimicrobial use in the United States. Overdiagnosis of and unnecessary prescribing for this condition has contributed to the spread of antimicrobial resistance. A critical step in reducing unnecessary prescribing is to identify the subset of patients who are unlikely to benefit from antibiotics. Conscientiously distinguishing acute otitis media (AOM) from otitis media with effusion (OME), and deferring antibiotics for OME will accomplish this goal, and will avoid up to 8 million unnecessary courses of antibiotics annually. Criteria for defining these conditions are presented, as well as the evidence supporting deferring antibiotic treatment. Discussions of shortened courses of antibiotics for AOM and restricted indications for antimicrobial prophylaxis are also presented. Pediatrics 1998;101:165-171; antimicrobial resistance, antimicrobial use, otitis media, upper respiratory infection, antimicrobial therapy, pediatrics, acute otitis media, otitis media with effusion, prophylaxis.
ABBREVIATION. AHCPR, Agency for Health Care Policy and Research. PRINCIPLES 1. Episodes of otitis media should be classified as acute otitis media (AOM) or otitis media with effusion (OME). 2. [...]