Nonpharmacologic Therapy

Watchful waiting and safety-net antibiotic prescriptions (to be filled only if symptoms do not resolve after 48 hours' observation) are approaches being used more frequently to attenuate microbial resistance and avoid unnecessary adverse events and costs of antibiotics. Delayed antibiotic therapy in older children and those with less severe disease does not result in more infectious complications, such as mastoiditis or meningitis, when compared with routine initial antibiotic treatment.13,14 Use of an observation approach or use of a safety-net antibiotic prescription that can be filled 48 to 72 hours later if symptoms persist can reduce antibiotic use for AOM by 67% without increasing complications.14 Observation or delayed antibiotic therapy should be considered only in otherwise healthy children without recurrent disease (Fig. 72-1) and only if proper follow-up and good communication exist between clinicians and the parent/ 3,4,14


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