New insights into the treatment of acute otitis media

ABSTRACT

Introduction

Acute otitis media (AOM) affects most (80%) children by 5 years of age and is the most common reason children are prescribed antibiotics. The epidemiology of AOM has changed considerably since the widespread use of pneumococcal conjugate vaccines, which has broad-reaching implications for management.

Areas covered

In this narrative review, we cover the epidemiology of AOM, best practices for diagnosis and management, new diagnostic technology, effective stewardship interventions, and future directions of the field. Literature review was performed using PubMed and ClinicalTrials.gov.

Expert opinion

Inaccurate diagnoses, unnecessary antibiotic use, and increasing antimicrobial resistance remain major challenges in AOM management. Fortunately, effective tools and interventions to improve diagnostic accuracy, de-implement unnecessary antibiotic use, and individualize care are on the horizon. Successful scaling of these tools and interventions will be critical to improving overall care for children.

KEYWORDS:

• Acute otitis media
• amoxicillin
• antibiotic stewardship
• pneumococcal vaccines
• treatment

Article highlights

• The epidemiology of acute otitis media (AOM) has changed with the introduction of pneumococcal vaccines. Haemophilus influenzae and Moraxella catarrhalis are now more common; both organisms cause less severe disease compared toStreptococcus pneumoniae and are more likely to resolve spontaneously without antibiotics.

• Diagnosis of AOM relies on visualization of the tympanic membrane. New technology tools and artificial intelligence allow for higher accuracy and may be the future of AOM diagnostics.

• Delayed antibiotic prescriptions or watchful waiting are appropriate for many patients with AOM symptoms and can help avoid antibiotic exposure in a substantial number of children. However, most patients evaluated for AOM continue to receive immediate antibiotic prescriptions.

• Amoxicillin continues to be the first-line antibiotic for children with AOM and no recent antibiotic exposure or concomitant conjunctivitis.

• Multiple quality improvement efforts have been successful in increasing watchful waiting and reducing duration of antibiotics for AOM. These efforts typically include a combination of education, electronic health record changes, engagement strategies, and feedback to clinicians on their prescribing practices compared to those of their peers.

Declaration of interest

R El Feghaly has received a research grant from Merck. H Frost serves as a Senior Scientific Advisor for QuidelOrtho and holds a patent for Diagnosing and Treating Otitis Media #63/335,801. QuidoOrtho had no role in the design, content, or interpretation of the review. S Katz serves as a consultant for Optum and has a research grant from Pfizer, neither of which had any role in the design, content, or interpretation of the review. A Nedved serves as a project leader on an antibiotic stewardship project sponsored by the American Academy of Pediatrics and funded by Pfizer. A Nedved has a research grant from Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

H Frost received salary support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number [K23HD099925]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.