title: Acute otitis media--a structured approach.
abstract: BACKGROUND
  Two-thirds of all children have an episode of acute otitis media (AOM) before their third birthday. Antibiotic treatment is often given immediately, even though adequate scientific evidence for this practice is lacking.
  
  
  METHODS
  This review is based on a selective literature search including previously published evidence-based recommendations, particularly those of the current American guidelines.
  
  
  RESULTS
  A purulent tympanic effusion, possibly associated with inflammation of the tympanic membrane, is indicative of AOM. Only some patients with AOM need immediate antibiotic treatment: children with severe otalgia and/or fever of 39.0°C or above, infants under 6 months of age, and children with certain specific risk factors, including immune deficiency and Down syndrome. In other cases, symptomatic treatment is appropriate. Antibiotic therapy (preferably with amoxicillin) should be initiated only if the symptoms and signs do not improve within two to three days.
  
  
  CONCLUSIONS
  As the currently available data are not fully consistent, there is still a need for controlled trials with well-defined endpoints to determine the relative benefits of immediate antibiotic treatment versus two to three days of watchful waiting.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Ruhr University of Bochum, Department of Child and Adolescent Medicine, Technical University of Dresden(Carl Gustav Carus University Hospital Dresden), Department of Otorhinolaryngology, Technical University of Dresden (Carl Gustav Carus University Hospital Dresden).
authors.forename: Jan Peter
authors.initials: JP
authors.lastname: Thomas
authors.forename: Reinhard
authors.initials: R
authors.lastname: Berner
authors.forename: Thomas
authors.initials: T
authors.lastname: Zahnert
authors.forename: Stefan
authors.initials: S
authors.lastname: Dazert
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006801:Humans; D010033:Otitis Media / Q000175:diagnosis* / Q000628:therapy*; D010036:Otolaryngology / Q000592:standards*; D017410:Practice Guidelines as Topic
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents