General Approach to Treatment

O The majority of uncomplicated AOM cases resolve spontaneously without significant morbidity. Untreated AOM improves in 80% of children between days 2 and 7 of illness without increasing the risk of complications.13 Antibiotics improve ear pain in only 7% of children between days 2 and 7 of therapy and significantly improve recovery in children younger than 2 years of age and in those with severe AOM symptoms.13 Therefore, antibiotics should be reserved for children most likely to benefit from therapy and is dependent upon patient age, illness severity, and diagnostic certainty. Children younger than 2 years of age have a higher incidence of penicillin-resistant pneumococcal infections and have higher clinical and bacteriolo-gic failure rates and complications when not treated initially with antibiotics as compared with older children.4 Patients with severe illness, defined by degree of fever and pain severity, have lower spontaneous recovery rates than those with less severe dis-13

ease. Current guidelines recommend stratifying patients based on these criteria in order to identify those most likely to benefit from antibiotic therapy.4

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