Research Letter |

Acute Otitis Media in Children Younger Than 2 Years

Alejandro Hoberman, MD1; Aino Ruohola, MD, PhD2; Nader Shaikh, MD, MPH1; Paula A. Tähtinen, MD, PhD2; Jack L. Paradise, MD1
[+] Author Affiliations
1Department of Pediatrics, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
2Department of Pediatrics, Turku University Hospital, Turku, Finland
JAMA Pediatr. 2013;167(12):1171-1172. doi:10.1001/jamapediatrics.2013.3068.
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A recent American Academy of Pediatrics (AAP) guideline recommends prompt antimicrobial treatment for children aged 6 months to 2 years with acute otitis media (AOM), with 1 exception: for children in whom the disease is unilateral and also unaccompanied by severe signs or symptoms, the guideline recommends, as an option, observation without initial antimicrobial therapy.1 The recommendation is based on findings from certain clinical trials that suggested little benefit of antimicrobial treatment in such children.2 In those trials, however, criteria used for the diagnosis of AOM were not as stringent as those called for in the recent AAP guideline,1 allowing for the possibility that some of the subjects in those trials did not actually have AOM. Our findings in 2 independent clinical trials,3,4 both of which used stringent diagnostic criteria consistent with those in the recent guideline,1 offer a differing perspective on the relative efficacy of antimicrobial treatment in children younger than 2 years with unilateral, nonsevere AOM.

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