Managing acute otitis media: a summary of recommendations

  • NICE

  • from Pavankumar Kamat
  • Clinical Guidance Summaries
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Takehome

  • The Latest NICE guidance on otitis media aims to limit antibiotic use and reduce antimicrobial resistance.
  • Most children get better in 3 days without antibiotics. Serious complications are rare.

Assessment

  • Clinicians should be aware that otitis media is a self-limiting infection typically affecting children.
  • Acute otitis media can be caused by viruses and bacteria, and it is difficult to distinguish between these (both are often present at the same time).
  • Symptoms may last from up to 3 days to a week.
  • Most patients achieve complete recovery without antibiotics within 3 days.
  • Acute complications, including mastoiditis are rare.
  • Evaluate and manage children aged NICE guideline.
  • Advise about the usual course of acute otitis media, and self-care.
  • Reassess if symptoms worsen rapidly or substantially:
    • Consider alternative diagnoses, e.g. glue ear
    • Possibility of a more serious illness or condition.
    • Evaluate previous antibiotic use for suspected resistance.

Management

  • Individuals systemically very unwell, likely to have serious illness or condition, or at high-risk of complications
    • Offer immediate antibiotic therapy along with advice or consider for further investigation and management.
    • Refer children and young people with severe systemic infections or acute complications for hospital admission.
  • Individuals more likely to benefit from antibiotics (otorrhoea in any child/young adult or child
  • Offer no antibiotic, back-up antibiotic, or an immediate antibiotic considering rare occurrence of acute complications regardless of antibiotic use, and potential side effects of antibiotics.
  • Caution patients/parents/carers to seek medical help if symptoms fail to improve after 3 days with an immediate antibiotic prescription
  • Give advice about seeking medical help if symptoms worsen rapidly or significantly, or the child or young person becomes systemically very unwell.
  • Individuals less likely to benefit from antibiotics
    • Offer no antibiotic or a back-up antibiotic considering very little symptomatic improvement, very little effect on the development of complications (short-term hearing loss, perforated tympanum or recurrent infection), rare occurrence of acute complications regardless of antibiotic use, and potential side effects of antibiotics such as nausea and diarrhoea.
    • Advice patients/parents/carers about the rationale of not using antibiotics or using backup antibiotics. They should be cautioned to seek medical help if symptoms fail to improve after 3 days with the above interventions.
    • Give advice about seeking medical help if symptoms worsen rapidly or significantly, or the child or young person becomes systemically very unwell.
  • Self-care

    • Manage pain in children and young people with regular doses of paracetamol or ibuprofen adjusted for the age or weight. Consider maximum recommended doses for severe pain.
    • There is no evidence to support symptomatic benefits with decongestants or antihistamines. 

    Antibiotic choice for children and young people

    • The first-choice antibiotic is amoxicillin.
    • For those with an allergy or intolerance to penicillins, alternative first choices include clarithromycin and erythromycin.
    • If symptoms worsen after 2-3 days on the first choice, the preferred second choice antibiotic is co-amoxiclav.
    • For those with an allergy or intolerance to penicillins, consult local microbiologist for alternative second choices.

    This summary is reviewed by Prof.  Rishabh Prasad  MBBS, MA, MSC, FRCGP FRSA

    Please read linked summary of NICE guidance "Sore throat"

    Please read linked summary of NICE guidance "Antimicrobial Stewardship"