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Acute Otitis Media Update

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Acute otitis media (AOM), characterized by the rapid onset of symptoms such as ear pain and fever, is one of the most common childhood infections. It is the leading reason for both doctor office visits (aside from well child visits) and antibiotic prescriptions for children. An estimated 60% to 80% of infants have at least 1 episode of AOM by 12 months of age, and up to 90% have had an episode by 2 to 3 years of age. Most cases occur between the ages of 6 months and 24 months. Infants with AOM during the first 6 months of life are more likely to have frequent episodes during the next few years.

In recent decades, there has been a decrease in doctor office visits for AOM. The reasons for this decline are not clear, but may include the introduction of new PCV pneumococcal vaccines, more widespread influenza vaccination (see Prevention Through Immunization, below) and public education about unnecessary antibiotic use, resulting in fewer visits for mild ear infections. More healthcare providers may also be following the “watchful waiting” recommendations that were advocated in the 2004 American Academy of Pediatrics and American Academy of Family Physicians (AAP/AAFP) otitis media guideline.

In 2013, the American Academy of Pediatrics (AAP) released a new guideline for the diagnosis and management of AOM in children 6 months through 12 years of age. The new guideline focuses on more stringent, objective criteria for AOM diagnosis. Observation rather than antibiotic initiation in selected cases continues to be emphasized in the 2013 guideline, including in selected children younger than 2 years old. The appropriate choice of antibiotic, based on the changing microbiology of AOM, is also emphasized. This issue reviews key points in the new guideline, along with the basic pathophysiology, risk factors, and prevention of AOM. Community providers have an important role in educating parents and caregivers about the best management strategies for AOM, including the avoidance of unnecessary antibiotic use.


Publication Date: 03/18/2014
Expiration Date: 03/18/2017
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


Sarah Scarpace Lucas, PharmD, BCPS, FCSHP

Disclosure Statement

Dr. Lucas reports no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Describe the signs and symptoms of acute otitis media (AOM), and state the current criteria for diagnosing AOM.
    2. Identify at least 5 modifiable risk factors for AOM. Counsel parents about vaccinations that may help prevent AOM.
    3. List the 3 major bacterial species that cause AOM and describe their patterns of antibiotic susceptibility.
    4. Counsel parents about pain medication for AOM. Review current recommendations for antibiotic use versus observation, and for 1st- and 2nd-line antibiotic choices. Discuss common adverse effects of amoxicillin.

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ACPE Universal Activity Number: 0428-0000-14-005-H01-P

Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator

Terry M. Baker, PharmD

Managing Editor

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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