title: Who needs admission among infants with acute otitis media?
abstract: OBJECTIVE
  Management of acute otitis media (AOM) in infants younger than 2 months old is controversial. It varies between treatment on an outside basis, and hospitalization for intravenous antibiotics and sepsis work-up based on variability of the reported AOM pathogens in this particular group. Our aim is to identify clinical indicators that may suggest a need for an invasive medical work-up and/or hospitalization of these young patients, and compare their management to that of older infants.
  
  
  METHODS
  Retrospective chart review. Admitted infants with AOM and a random sample of infants presenting to the emergency room with AOM over a 20-year period. Infants younger than 2 months were designated as 'young infants', and those older as 'older infants'. Demographic data, relevant history, physical examination, laboratory studies and treatment were reviewed.
  
  
  RESULTS
  Twenty-nine admitted infants were included (13 young infants). A sample of 58 outpatients was studied, including two young infants. Compared to older inpatient infants, admitted young infants were less febrile (P < 0.05), had more benign white cell count (P < 0.05) but had more otorrhea (P < 0.05). These grew gram-negative organisms. Sepsis work-up was negative. Young infants were more likely to be admitted (P < 0.05). Admitted older infants had more otorrhea than outpatients (P < 0.05) or a complication (P < 0.05).
  
  
  CONCLUSIONS
  Young infants often need admission for intravenous antibiotics, until middle ear culture is out. Sepsis work-up may be necessary only in toxic patients. Older infants need admission when severely ill or have a complication.
authors: Department of Otolaryngology Head and Neck Surgery, American University of Beirut School of Medicine and Medical Center, Beirut, Lebanon. mb36@aub.edu.lb
authors: Mohamed A
authors: MA
authors: Bitar
authors: Rami
authors: R
authors: Baz
authors: Omar
authors: O
authors: Sabra
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010033:Otitis Media / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D010343:Patient Admission / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000175:diagnosis
chemical_list: D000900:Anti-Bacterial Agents