P.E.A.R.L.S: Practical Evidence About Real Life Situations, Otitis Media Aguda

P.E.A.R.L.S          Practical Evidence About Real Life Situations



Antibiotics or ‘watch and wait’ for acute otitis media


Clinical Question

How should I treat uncomplicated acute otitis media (AOM)?

Bottom line

Immediate antibiotic treatment reduces earache/fever or both at 3-7 days:

<2 years + bilateral AOM     NNT* = 4

<2 years + unilateral AOM   NNT = 20

≥ 2 years + bilateral AOM     NNT = 9

≥ 2 yrs + unilateral AOM    NNT = 15 Watch and wait may be appropriate for unilateral AOM except in children under 6 months of age. Most guidelines recommend routine antibiotics for children less than 6 months.


*NNT = number needed to treat to benefit one individual.


Adverse events reported included diarrhoea (4-21% of children in the treatment groups, 2-14% in the control groups), and rash (1-8% in the treatment groups and 2-6% in the control groups). No serious adverse events were reported.

Children with a temperature >37.5 C and vomiting are more likely to be distressed or have night disturbance after 3 days and would appear to benefit from antibiotics.1


AOM is very common in preschool children, uncommon in older children and very rare in adults.

Systematic Review

Rovers MM et al. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet 2006;368:1429-35. This review contains 6 studies involving 1643 patients.

PEARLS No. 21, November 2007, written by Brian R McAvoy                    

1. Little P, et al. Predictors of poor outcomes and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial. BMJ 2002;325:22-25. This is a single study involving 315 patients.

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