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A large multi-system analysis of 140,579 pediatric acute otitis media (AOM) visits published in the Journal of the Pediatric Infectious Diseases Society found “watchful waiting” was used in only 15.6% of cases—even though watchful waiting is often a beneficial approach, according to the authors. The watchful waiting group was either sent home without a prescription (56%) or received a delayed prescription (44%). Meanwhile, the remaining 84% of AOM cases received immediate antibiotics. Both groups had comparable outcomes, and medically attended adverse events were rare (<1%) across all cases. Comparing prescriptions for antibiotics at later visits specifically for AOM between day 3-14 after the initial AOM visit, authors found antibiotic prescriptions were written in just 1% of cases in both the watchful waiting group and the group with initially prescribed antibiotics. Data also showed that new antibiotic prescriptions for any reason within 3-30 days after the index visit were 6% when watchful waiting was used, and 7% for the immediate antibiotic group. Because most AOM cases improve without treatment, and failure rates were similarly low, the authors conclude that watchful waiting is a safe and effective approach. Therefore, they say, promoting watchful waiting may substantially reduce unnecessary antibiotic use for AOM.
AOM in urgent care: About 100 million antibiotic courses are prescribed for children with AOM annually across all settings of care. In this particular study, 65,161 (46% of total) cases were seen in urgent care with 55,729 receiving immediate antibiotics and 9,432 treated with watchful waiting.