PE25.1 | Acute Otitis Media — Summary & Reflection

KEY TAKEAWAYS

Acute otitis media is a suppurative infection of the middle ear, most common in children under 5 years. The three principal bacterial pathogens are Streptococcus pneumoniae (most common and most virulent), non-typeable Haemophilus influenzae, and Moraxella catarrhalis. The pathogenesis follows URTI → Eustachian tube dysfunction → middle-ear effusion → bacterial infection. Diagnosis requires otoscopic confirmation of a bulging, erythematous tympanic membrane with middle-ear effusion. Watchful waiting (48-72 hours, analgesics only) is appropriate for non-severe, unilateral AOM in children ≥6 months; however, bilateral AOM in children <2 years, severe symptoms, or any AOM in infants <6 months mandates immediate antibiotic therapy. First-line treatment is high-dose amoxicillin at 80-90 mg/kg/day for 10 days (or 5-7 days in mild AOM in children ≥2 years). Treatment failure prompts switching to amoxicillin-clavulanate. Complications include mastoiditis, CSOM, and rare intracranial extension.

REFLECT

Think about the last time you or a family member was prescribed an antibiotic for an ear infection. Were the criteria for watchful waiting considered? As a future clinician, you will face parental pressure to prescribe antibiotics for every febrile child with ear pain. Reflect on how you will communicate the rationale for watchful waiting to an anxious parent who expects a prescription, and how you will set up a reliable safety net — explaining exactly when to return and what to watch for. How does antibiotic stewardship in AOM connect to the broader challenge of antimicrobial resistance in your community?