TABLE 4.

Criteria for Initial Antibacterial-Agent Treatment or Observation in Children With AOM

AgeCertain DiagnosisUncertain Diagnosis
<6 moAntibacterial therapyAntibacterial therapy
6 mo to 2 yAntibacterial therapyAntibacterial therapy if severe illness; observation option* if nonsevere illness
≥2 yAntibacterial therapy if severe illness; observation option* if nonsevere illnessObservation option*
  • This table was modified with permission from the New York State Department of Health and the New York Region Otitis Project Committee.32,33

  • * Observation is an appropriate option only when follow-up can be ensured and antibacterial agents started if symptoms persist or worsen. 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.