Acute Otitis Media, Update

Full Title: Management of Acute Otitis Media, Update

Expected Release Date: late 2009

Key Questions

1. What is the validity of clinical symptoms and otoscopic findings such as a bulging tympanic membrane to diagnose acute otitis media (AOM)? Do these clinical findings aid physicians in distinguishing AOM from otitis media with effusion (OME)?
   
2. 1. What organisms (bacterial and viral) are associated with otitis media since the introduction of pneumococcal conjugate vaccine (PNC7)?
   2. What are the patterns of antimicrobial resistance since the introduction of PNC7?
   • New infections.
   • Recurrent infections.
   
   

3. What is the comparative effectiveness of different treatment options (defined below) for treating AOM in average risk children ages <2 years, ages 2 years to <5years and ages >5 years?

   Treatment options include but not limited to:

   • Amoxicillin (including high dose versus low dose).
   • Amox-clav (including high dose versus low dose).
   • Cephalosporins (e.g. ceftriaxone, cefdinir, cefixime).
   • "Wait and see approach".
   • Placebo.
   • Duration of treatment.

   Outcomes to consider but not limited to:

   • Parent satisfaction.
   • Duration of symptoms/illness.
   • Treatment failure, mastoiditis, bacteremia, clinical cure, bacteriologic cure.
   • Disease recurrence.
   
   

4. What is the comparative effectiveness of different management options for recurrent otitis media?

   Management options include but not limited to:

   • Amox-clav.
   • Cephalosporins (e.g. ceftriaxone, cefuroxime).
   • Quinolones.
   • Antibiotic prophylaxis.

   Outcomes to consider but not limited to:

   • Parent satisfaction.
   • Duration of symptoms/illness.
   • Treatment failure, mastoiditis, bacteremia/cure rates.
   
   

5. What is the evidence that the comparative effectiveness of different treatment options in KQ #33 differs in subpopulations of patients?

   Subpopulations to include (but not limited to):

   • Bilateral disease.
   • Commorbidities (e.g. asthma -will need to define further).
   • Age groups (e.g. <1 month, 1-<2 mos, 2-<6 mos, 6 mos-<2 years, 2-5 years).
   • Race/Ethnicity.
   • Day care attendance.
   
   

6. What are the comparative harms of different treatment options?

   Outcomes to consider (but not limited to):

   • Antibiotic resistance.
   • Diarrhea/vomiting.

Current as of June 2008

Internet Citation:

Management of Acute Otitis Media, Update, Clinical Focus. June 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/otitisuptp.htm