title: Update on acute otitis media in children younger than 2 years of age.
abstract: OBJECTIVE
  As concern about antimicrobial resistance grows, I am aware of the need to reduce unnecessary antibiotic treatment; however, in my practice I see many children with acute otitis media (AOM) and this is the most common reason I prescribe antibiotics. Most of these children are young and otherwise healthy, and I am uncertain about when to prescribe antibiotics and when to endorse "watchful waiting." Which children will benefit from antibiotic treatment?
  
  
  CONCLUSIONS
  Current Canadian guidelines recommend all children younger than 2 years of age with otalgia due to AOM and fever greater than 39°C be considered for treatment with amoxicillin. Watchful waiting is indicated only for children older than 6 months with mild-to-moderate AOM. Recent evidence suggests young children with a definitive diagnosis of AOM will benefit from antibiotics and experience fewer treatment failures compared with placebo, regardless of the severity of otitis. These studies do not challenge watchful waiting directly, and determining which children will improve spontaneously remains an enigma.
authors.affiliation: Pediatric Research in Emergency Therapeutics (PRETx) program, BC Children's Hospital, Vancouver, BC.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: McWilliams
authors.forename: Ran D
authors.initials: RD
authors.lastname: Goldman
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002170:Canada; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D010033:Otitis Media / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D057832:Watchful Waiting
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin
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