Canadian Pediatric Society If the child is older than six months of age with mild signs and symptoms

, observation without the use of antimicrobials for 48 h to 72 h may be an option if follow-up can be assured

AAP Nonsevere illness is mild otalgia and fever >39°C in the past 24 hours. Severe illness is moderate to severe otalgia or fever >39°C. A certain diagnosis of AOM meets all 3 criteria: 1) rapid onset 2) signs of MEE, and 3) signs and symptoms of middle-ear inflammation.

Risk factors for the presence of bacterial species likely to be resistant to amoxicillin include attendance at child care, recent receipt (less than 30 days) of antibacterial treatment, and age younger than 2 years.96,97

Scottish Intercollegiate Network (RCP)

pneumoniae and beta-lactamase-positive H. influenzae. Pediatric Infectious Disease 2005 CONCLUSION: Amoxicillin/clavulanate was clinically and bacteriologically more effective than azithromycin among children with bacterial AOM. . when • symptoms were already resolving • immediate antibiotics increased the incidence of diarrhoea by 10% • only 24% of the parents in the delayed prescription group used antibiotics • a wait and see approach in the management of AOM is feasible and acceptable to most parents and results in a 76% reduction in the use of antibiotic prescriptions. including cases caused by penicillin-resistant S.conclusions from this trial were that: • immediate antibiotics provided symptomatic benefit mainly after the first 24 hours.

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