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The “observation option” for acute otitis media (AOM) — giving families a prescription to fill only if their child does not improve — has gained popularity and has been shown to markedly reduce antibiotic prescription use (see Journal Watch Pediatrics and Adolescent Medicine Oct 11 2006). The AAP has endorsed this management option for children aged 6 months and older who have nonsevere illness (mild otalgia and fever <39°C). However, knowing which children benefit most from antibiotic treatment versus observation would be helpful. In two large studies, investigators compared microbiologic results from tympanocentesis and middle ear fluid culture in children with bilateral or unilateral AOM.
Investigators in Texas evaluated 566 children with…