Antibiotics for Acute Otitis Media in Young Children

Andrea: Acute otitis media (AOM) in children represents a significant burden to the U.S. economic and health care systems, including the direct costs of care (e.g., office visits), indirect costs of care (e.g., development of antibiotic resistance), and social costs (e.g., loss of time from work). Because of this, there is significant selection bias in these studies toward patients who have “real” disease. Diagnostic criteria for AOM include rapid onset of signs and symptoms of middle ear effusion and inflammation; documentation of the presence of middle ear effusion (includes any of the following: bulging tympanic membrane, decreased mobility of the tympanic membrane, air-fluid level behind the tympanic membrane, otorrhea); and documentation of middle ear inflammation (tympanic membrane erythema or distinct otalgia that limits normal daily activities or interrupts sleep).1 We make a clinical judgment based on a quick peek at the ear, so the effectiveness of antibiotic treatment will necessarily be less in our practices because we treat many children who would not meet the strict definition of AOM. [...]in the Hoberman, et al., study, six children in the amoxicillin/clavulanate group developed Clostridium difficile colitis, compared with one child in the placebo group.