Diagnosis and treatment of acute otitis media: review

J Laryngol Otol. 2012 Oct;126(10):976-83. doi: 10.1017/S0022215112001326. Epub 2012 Jul 19.


Background: Acute otitis media is very common, but diagnostic criteria and treatment recommendations vary considerably.

Methods: Medline, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched using the key words 'acute otitis media' AND 'diagnosis' OR 'diagnostic criteria' OR 'definition', and by combining the terms 'acute otitis media' AND 'guidelines'. PubMed was searched using the key words 'mastoiditis' and 'prevalence'.

Results: The 11 most recently published guidelines unanimously agreed that adequate analgesia should be prescribed in all cases. The majority recommended that routine antibiotic prescription should be avoided in mild to moderate cases and when there was diagnostic uncertainty in patients two years and older. Antibiotics were recommended in children two years and younger, most commonly a 5-day course of amoxicillin (or a macrolide in patients allergic to penicillin).

Conclusion: Level 1A evidence shows that selected cases of acute otitis media benefit from antibiotic prescription.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Analgesics / therapeutic use
  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Humans
  • Middle Ear Ventilation
  • Otitis Media / complications
  • Otitis Media / diagnosis*
  • Otitis Media / drug therapy
  • Otitis Media / therapy*
  • Practice Guidelines as Topic


  • Analgesics
  • Anti-Bacterial Agents