CLINICAL PRACTICE GUIDELINE The Diagnosis and Management of Acute Otitis Media

This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM. In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships. The practice guideline underwent comprehensive peer review before formal approval by the AAP. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem. Pediatrics 2013;131:e964–e999 Allan S. Lieberthal, MD, FAAP, Aaron E. Carroll, MD, MS, FAAP, Tasnee Chonmaitree, MD, FAAP, Theodore G. Ganiats, MD, Alejandro Hoberman, MD, FAAP, Mary Anne Jackson, MD, FAAP, Mark D. Joffe, MD, FAAP, Donald T. Miller, MD, MPH, FAAP, Richard M. Rosenfeld, MD, MPH, FAAP, Xavier D. Sevilla, MD, FAAP, Richard H. Schwartz, MD, FAAP, Pauline A. Thomas, MD, FAAP, and David E. Tunkel, MD, FAAP, FACS