Information about THE current guideline

In February 2013, the American Academy of Pediatrics (AAP) published a revised clinical guideline on The Diagnosis and Management of Acute Otitis Media in children aged 6 months to 12 years.1 This guideline review summarises this guidance and compares it with UK guidance on acute otitis media (AOM).

The AAP guidance is specific to uncomplicated AOM (see box 2) in an otherwise healthy child. The guidance does not apply to children with underlying conditions that may alter the natural course of AOM, for example, the presence of grommets, cleft palate, immune deficiencies and craniofacial abnormalities.

The revised 35-page AAP guidance culminates into 17 action statements and, of particular note, clearer diagnostic guidelines and definitions for AOM and guidance on the management of recurrent AOM. Furthermore, there have been some changes in guidance in the use of antibiotics. It was previously recommended that all children between 6 months and 2 years of age with a certain diagnosis received antibiotics. Now the guidance offers a choice of either antibiotic therapy or initial observation for children with unilateral AOM and mild symptoms. The intended audience for the guideline includes primary care clinicians, paediatricians and family physicians, emergency department physicians, otolaryngologists, physician assistants and nurse practitioners.

UK guidelines

The National Institute of Health and Care Excellence (NICE) as part of its Clinical Knowledge Summaries (CKS) service to primary care practitioners in the UK has published an AOM CKS2 ,3 (see box 1). Of note, the AAP guidelines are specific to uncomplicated AOM (see box 2). However, NICE CKS does not make this distinction—all children with AOM are considered, as is their management (see figure 1). This includes potential admission in children <3 months of age, and when to refer for specialist assessment in cases of associated fever (see box 3).