Otitis Media

Don’t prescribe antibiotics in vaccinated children more than 6 months old, and adults, in whom you suspect acute otitis media, unless there is either:

1) a perforated tympanic membrane with purulent discharge OR
2) a bulging tympanic membrane with one of the three following criteria:

Fever (≥39°C)
Moderately or severely ill
Significant symptoms lasting > 48 hours

In cases that do not fit these criteria, consider either no prescription with reassessment if symptoms do not improve, or a delayed prescription approach. Don’t misinterpret a patient’s or parental concern for a desire for antibiotics. Symptom control and access to follow-up if needed are often what they are looking for.