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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
The AAP Otitis Media (OM) guidelines note that the majority of OM spontaneously resolves, with a number needed to treat (NNT) with antibiotics of 15-20 in low risk cases. Clinicians and parents can elect an “observation option” in select patients that are nontoxic, have temperature < 39 C, have had ear pain for < 48 hours, and have mild ear pain, and have no otorrhea; this applies to children aged 6-23 months with unilateral OM, and children > 24 months with bilateral OM. If symptoms persist for 48-72 hours, then antibiotics should be started.
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