of BL [ee Ty anere wo ae tr anoccla wl ery aay fanaa Tree tty reroned 9 sige Inthe rotus 9 ce Pose when muteow dae Serene esonmmoreicrg 4 cere cuits, or tse Nepean apo sa ee agp ae AP pr 8 ba TABLE 4 Recommendations for Initial Management for Uncomplicated AOM* nee Otorrhea Unilateral or Bilateral ADE Unilateral ADM® With Bilateral ADM* Without Otorrhea Without Otorrhea NOM! With Severe Symptoms” moto 2y Antibiotic Antibiotic -—Antibiotic therany Anibictic therapy or therapy therapy additional observation py Intibiotic Antibiotic Antibiotic therapy or Anibictic therapy or therapy therapy additional observation additional observation” * Apples any to children with well-documented A0M with high certainty of dagrosis (see Diagnosis section) ° 4 toxic anpearing child, persistent otalgia mare than 48 h, temperature >S9°C (1022°P) in the past 48 hor if there is ‘roertain access to follow-up afer the visit © Thi plan of inital managoront provides an opportunity for shared dossion making with tho child family for those ‘categories aporonriate for additional observation. f observation is offered, a machenism must be in place to ensure followup and begin antibiotics ifthe chile worsens or fais to improve within 48 to 72 h of AOM onset