Table 1.

Examples of national guidelines in AOM: scope and recommended first-line treatment

Guideline	Scope	First-line treatment
American Academy of Pediatrics and American	Pain management, initial observation versus antibacterial treatment, appropriate choices of antibacterials, and preventive measures	Analgesia
Academy of Family Physicians (AAP/AAFP 2004) [5]		Following certain diagnosis
		<2 years: antibiotics;
		>2 years; watchful waiting
Scottish Intercollegiate Guidelines Network (SIGN 2003) [88]	Detection, management, referral and follow-up of AOM and OM with effusion	Analgesia first-line
		Delayed antibiotic treatment after 72 h
National Institute of Clinical Excellence, UK (NICE 2008) [70]	Clinical effectiveness and cost effectiveness of antibiotic management strategies for respiratory tract infections	AOM—no antibiotic or delayed antibiotics
		And/or antibiotics for severe cases
		Bilateral AOM in children younger than 2 years
		AOM in children with otorrhoea
Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSAPS 2005) [2]	Best use of antibiotics for respiratory tract infection	<2 years: antibiotics
		>2 years: watchful waiting unless symptoms are severe then use antibiotics
		And/or delayed treatment after re-evaluation at 48–72 h
Ontario Guidelines Advisory Committee 2002 [71]	Antibiotic treatment in OM	For purulent OM with effusion or minimally symptomatic AOM
		Amoxicillin prescription to be filled within a week at the parent’s discretion, if symptoms are worsening
		Or deferred treatment following phone call to physician
Guidelines of the German society for pediatric infectious diseases [36]	Treatment of AOM	Symptomatic treatment (analgesia, nose drops) and watchful waiting for 24–72 h if second look is assured. Antibiotics first line (amoxicillin) in severe disease, age < 6 months, risk factors
Nederlands Huisarts Genootschap (NHG) [69]	Treatment of AOM	Analgesia (paracetamol)
		In case of worsening disease or children <2 year with bilateral acute OM: amoxicillin for 1 week (recommended alternatives azithromycin for 3 days or cotrimoxazole for 5–7 days)
Spanish Pediatric Association [23]	Treatment of AOM	Symptomatic treatment (paracetamol, ibuprofen)
		Children >2 years without poor prognostic factors, analgesic with reassessment after 48 h
		Antibiotic is recommended treatment for:
		Mild or moderate condition: amoxicillin, then amoxicillin-clavulanate (if clinical failure at 48–72 h of treatment)
		Severe conditions or less than 6 months: amoxicillin-clavulanate then if clinical failure at 48–72 h of treatment, tympanocentesis and treatment according to results of Gram staining and antibiotic sensitivity
		Previous treatment failure (lack of clinical response):
		amoxicillin-clavulanate then ceftriaxone, then tympanocentesis and treatment, according to Gram stain, culture, and sensitivity