Pediatra di libera scelta, ASL di Lanciano-Vasto (Chieti)
Key words: Antibiotics, Acute otitis media, Metanalysis
The Author reviews the available evidence on antibiotic treatment of Acute Otitis Media (AOM) on the basis of current evidence, including two recent metanalyses. Antibiotic treatment of AOM, given the self-limited character of AOM, produces little additional benefit. This can be quantified in earlier desappearance of hearache and reduced risk of controlateral otitis. Complications are exceedingly rare and never severe. However, on the basis of available studies, a few risk factors for failure (defined as late resolution, complication, or recurrence) can be identified for AOM: age less than 15 months and/or attendance of a day care centre, history of severe or recurrent or very recent otitis, otorrhea. These at risk children (usually representing not more than 10% of cases) should receive a 5-day course of antibiotic (amoxycillin), while the others can be treated with antinflammatory agents alone, with antibiotics restricted to cases that fail to improve after 2-3 days. This approach is advantageous also from the point of view of prevention of antibiotic resistance.
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