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Should We Reconsider How We Treat Acute Otitis Media?

June 3, 2022

Written by Clay Smith

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We are writing too many prescriptions for antibiotics for acute otitis media (AOM). Here is how we can improve.

Why does this matter?
Confession: I have been a 10-day AOM treater. But should I be? This opinion piece asks us to rethink the way we treat AOM in several ways.

Confessions of an overprescriber
This was an opinion piece in JAMA Peds that made so many important points about AOM that I just had to cover it on JF.

Here are the pearls.

  • We write 10 million antibiotic prescriptions a year for AOM.
  • Milder cases of AOM in children over age 2 can get a wait-and-see prescription; unfortunately, 95% of prescriptions are immediate.
  • In children over 2 years, 5-7 days is enough, but 94% of us write 10-day prescriptions.
  • 40% of prescriptions are for broad spectrum drugs like cefdinir or azithromycin instead of aminopenicillins.
  • Because of pneumococcal vaccination, AOM clears on its own 78-85% of the time, and the number needed to treat for symptomatic improvement has increased from 15 to 20.
  • This means up to 75% of antibiotics for AOM are potentially unnecessary. The number needed to harm is 5. So, we are likely doing more harm than good in many cases.
  • Serious complications from untreated AOM are rare.
  • The answers to overprescribing are: 1) observe more children, 2) use more wait-and-see prescriptions in milder cases over age 2 years, 3) limit duration to 5-7 days over age 2 years, and 4) use narrow-spectrum antibiotic choices whenever possible.

Rethinking Our Approach to Management of Acute Otitis Media. JAMA Pediatr. 2022 May 1;176(5):439-440. doi: 10.1001/jamapediatrics.2021.6575.

What are your thoughts?