What is known about prescribing antibiotics:

• Inappropriate use of antibiotics lead to adverse effects such as allergic reactions and gastrointestinal symptoms and enhance the risk of antimicrobial resistance.
• It is recommended to prescribe antibiotics in accordance with national guidelines.

How to talk with patients and parents about antibiotics:

• Acute otitis media is a self-resolving illness in the vast majority of cases. Antibiotics are not efficient in viral infections.
• Inappropriate use of antibiotics can lead to serious adverse effects and promotes antimicrobial resistance.
• Give your child painkillers to make him/her more comfortable. Antibiotics do not relieve pain in the first 24 hours and have only a small effect on pain after that.
• Vaccinate against S.pneumoniae.

This EAP recommendation is in accordance with Choosing Wisely recommendations of:

• Australia: https://www.choosingwisely.org.au/recommendations/racgp9

• Norway https://www.legeforeningen.no/kloke-valg/til-helsepersonell/legeforeningens-anbefalinger/norsk-barnelegeforening/unnga- rutinemessig-antibiotikabehandling-ved-akutt-orebetennelse-hos-barn-over-1-ar/

• Switzerland: https://cdn.paediatrieschweiz.ch/production/uploads/2022/03/PS_Choosingwisely_PDF_A3_EN_220314.pdf

• Canada: https://choosingwiselycanada.org/primary-care/antibiotics/#practice-statement

• USA: https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/cw-otitis-media.html

References:

• Del Castillo-Aguas G, et al. Acute otitis media management: A survey of European primary care pediatricians. Global Pediatrics 2023; 4 100057. https://doi.org/10.1016/j.gpeds.2023.100057

• Le Saux N, et al. Canadian Paediatric Society, Infectious Diseases and Immunization Committee. Management of acute otitis media in children six months of age and older. Paediatr Child Health. 2016; 21(1):39-50. PMID: 26941560

• Lieberthal AS, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013; 131(3):e964-999. PMID: 23439909 Marchisio P, et al. Italian panel for the management of acute otitis media in children. Updated guidelines for the management of acute otitis media in children by the Italian society of pediatrics: treatment. Pediatr Infect Dis J. 2019; 38(12S Suppl):S10-S21. PMID: 31876601

• NICE guidelines 2022. Otitis media (acute): antimicrobial prescribing. https://www.nice.org.uk/guidance/ng91

• Suzuki HG, et al. Clinical practice guidelines for acute otitis media in children: a systematic review and appraisal of European national guidelines. BMJ Open. 2020; 10(5):e035343. PMID: 32371515

• Thomas JP, et al. Acute otitis media–a structured approach. Dtsch Arztebl Int. 2014; 28;111(9):151-9; PMID: 24661591

• Venekamp RP, et al. Antibiotics for acute otitis media in children. Cochrane Database of Systematic Reviews 2023, Issue 11. Art. No.: CD000219. PMID: 37965923