Table 2

 Key points of the two guidelines: management

Scottish Intercollegiate Guideline NetworkAmerican Academy of Pediatrics
Parents should give paracetamol forThe management should include an assessment of pain
analgesia but should be advised of the potential danger of overuse [grade D]If pain is present, the clinician should recommend treatment to reduce pain. Strong recommendation based on randomised, clinical trials with limitations and a preponderance of benefit over risk
A table indicates that acetaminophen (paracetamol), ibuprofen are the mainstay of pain management
Insertion of oils should not be prescribed for reducing pain in children with acute otitis media [grade B]Oil may have limited effectiveness
Children with acute otitis media should not be prescribed decongestants or antihistamines [grade A]
Children diagnosed with acute otitis media should not routinely be prescribed antibiotics as the initial treatment [grade B]Observation without use of antibacterial agents in a child with uncomplicated acute otitis media is an option for selected children based on diagnostic certainty, age, illness severity, and assurance of follow up. Option based on randomised, controlled trials with limitations and a relative balance of benefit over risk
Broad spectrum antibiotics such as amoxicillin, or amoxicillin with clavulanic acid, are the drugs of choice if an antibiotic is to be usedIf a decision is made to treat with an antibacterial agent, the clinician should prescribe amoxicillin for most children. Recommendation
If an antibiotic is to be prescribed, the conventional five day course is recommended [grade B]. The optimum duration of treatment for infants and very young children, and for children with severe acute otitis media, has yet to be establishedFor younger children and for children with severe disease, a standard 10 day course is recommended. For children 6 years of age or older with mild to moderate disease, a 5–7 day course is appropriate
Delayed antibiotic treatment (antibiotic to be collected at parents’ discretion after 72 hours if the child has not improved) is an alternative approach which can be applied in general practice [grade B]If the patient fails to respond to the initial management option within 48–72 hours, the clinician must reassess the patient to confirm acute otitis media and exclude other causes of illness. If acute otitis media is confirmed in the patient initially managed with observation, the clinician should begin antibacterial treatment. If the patient was managed with an antibacterial agent, the clinician should change the antibacterial agent
No recommendation can be made regarding the use of homeopathy in the treatment of acute otitis mediaNo recommendations for complementary and alternative medicine for treatment of acute otitis media are made based on limited and controversial data