Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Treatment

and the Italian Panel for the Management of Acute Otitis Media in Children, Paola Marchisio, Luisa Galli, Barbara Bortone, Martina Ciarcià, Marco Antonio Motisi, Andrea Novelli, Luciano Pinto, Sergio Bottero, Lorenzo Pignataro, Giorgio Piacentini, Roberto Mattina, Renato Cutrera, Attilio Varicchio, Gian Luigi Marseglia, Alberto Villani, Elena Chiappini

Research output: Contribution to journalArticlepeer-review


BACKGROUND: New insights into the diagnosis, treatment and prevention of acute otitis media (AOM) have been gained in recent years. For this reason, the Italian Paediatric Society has updated its 2010 guidelines. METHODS: A literature search was carried out on PubMed. Only pediatric studies published between January 1, 2010 and December 31, 2018 in English or Italian were included. Each included study was assessed according to the GRADE methodology. The quality of the systematic reviews was assessed using AMSTAR 2. The recommendations were formulated by a multidisciplinary panel of experts. RESULTS: Prompt antibiotic treatment is recommended for children with otorrhea, intracranial complications and/or a history of recurrence and for children under the age of 6 months. For children 6 months to 2 years of age, prompt antibiotic treatment is recommended for all forms of unilateral and bilateral AOM, whether mild or severe. Prompt antibiotic treatment is also recommended for children over 2 years with severe bilateral AOM. A watchful-waiting approach can be applied to children over 2 years with mild or severe unilateral AOM or mild bilateral AOM. High doses of amoxicillin, or amoxicillin-clavulanic acid for patients with a high risk of infection by Beta-lactamase producing strains, remain the first-line antibiotics. CONCLUSIONS: AOM should be managed on a case-by-case basis that takes account of the child's age, the severity of the episode and whether it is unilateral or bilateral. In patients under 2 years, prompt antibiotic treatment is always recommended.

Original languageEnglish
Pages (from-to)S10-S21
JournalThe Pediatric infectious disease journal
Issue number12S Suppl
Publication statusPublished - Dec 1 2019

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases


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