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societies have examined the benefits and choice of antibiotics used for this disease The AAP/AAFP guidelines stress the need to improve accuracy of diagnosis and to use antibiotics judiciously in treating AOM Using the best available literature, including randomized clinical trials and cohort studies of patients with suspected AOM treated with antibiotics versus those treated with observation, the AAP/AAFP panel concluded that 80% of children who were not treated with antibiotics had spontaneous resolution of symptoms within a 2- to 7day onset of symptoms With this information, the panel suggested that a period of observation might be appropriate for otherwise healthy patients with AOM However, very young children, those with immune, genetic, or craniofacial anomalies, known or underlying OME, or recent AOM in the previous 30 days should not be considered candidates for this option because they are more likely to suffer adverse consequences from observation alone The panel also specified that the observation option must be used only if there is a high probability that the parent will be compliant in returning for evaluation if symptoms of AOM persist over the next 72 hours Specific recommendations therefore vary by age and severity of illness Any patient younger than months should be treated with antibiotics The observation option is recommended for children months to years of age whose baseline health is good and who are not ill at presentation without evidence of severe disease The option of observation is also available for children older than years, with nonsevere illness at presentation ( Table 118.1 ) In prospective studies, 25% of those children did eventually require antibiotic upon follow-up within 48 to 72 hours With regard to follow-up, the guidelines suggest that the observed patients be contacted or seen within 72 hours so that they may be treated if symptoms persist Other authors have advocated writing a “safety net prescription” to be given to parents of children who are observed at the time of the initial assessment with instructions to fill it if symptoms persist Guidelines for intervention for persistent or recurrent AOM vary Patients with multiple episodes of AOM over a period of months, OME lasting more than to weeks, complications of middle ear disease, or associated hearing or speech concerns should be referred to an otolaryngologist for evaluation for possible surgical treatment (myringotomy and tube placement) To effectively treat AOM, the most important pathogen to address is S pneumoniae because it is less likely to resolve spontaneously without treatment compared with H influenzae and M catarrhalis Although a large number of species exist that are resistant to amoxicillin and cephalosporins, evidence from
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