TABLE 4

Recommendations for Initial Management for Uncomplicated AOM^a

Age	Otorrhea With AOMa	Unilateral or Bilateral AOMaWith Severe Symptomsb	Bilateral AOMa Without Otorrhea	Unilateral AOMa Without Otorrhea
6 mo to 2 y	Antibiotic therapy	Antibiotic therapy	Antibiotic therapy	Antibiotic therapy or additional observation
2 y	Antibiotic therapy	Antibiotic therapy	Antibiotic therapy or additional observation	Antibiotic therapy or additional observationc

^a Applies only to children with well-documented AOM with high certainty of diagnosis (see Diagnosis section).
^b A toxic-appearing child, persistent otalgia more than 48 h, temperature ≥39ºC (102.2ºF) in the past 48 h, or if there is uncertain access to follow-up after the visit.
^c This plan of initial management provides an opportunity for shared decision-making with the child’s family for those categories appropriate for additional observation. If observation is offered, a mechanism must be in place to ensure follow-up and begin antibiotics if the child worsens or fails to improve within 48-72 h of AOM onset.
Source: Lieberthal AS, Carroll AE, Chonmaitree T et al. AAP Clinical Practice Guideline: The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3);1451–1465