Periodic Survey of Fellows
AAP News 3/94

In an AAP-conducted survey, 70 percent of pediatricians asked said they would begin otitis media treatment, in an otherwise healthy young child, with antibiotic therapy, continuing for 20.8 days.

Forty-four percent chose amoxicillin. Nearly one-fourth (24 percent) said they would wait 4.9 weeks before initiating further therapy.

Nineteen percent said they would begin antihistamine/decongestant therapy, most often in combination with antibiotic or other treatment, for 16.6 days. Dimatapp was the favored antihistamine for 29 percent of respondents.

If effusion persisted for six weeks, 37 percent of pediatricians who initially prescribed antibiotics said they would change to amoxicillin/Clavulante for 15 days, or Cefaclor for 13 days. Another 37 percent said they would consult and/or refer for additional treatment, and 22 percent said they would perform or refer for myringotomy or tube surgery.

Pediatricians who initially recommended combination antibiotic/antihistamine/decongestant therapy would choose alternative treatments similar to alternatives chosen by those who initially prescribed antibiotics only.

Few respondents said they would continue therapy unchanged, begin steroids or begin or change antihistamines/decongestants if otitis media with effusion persisted. Almost half (48.6 percent) said they would not consider antibiotic prophylaxis to prevent recurrences, 35 percent said they would, and 17 percent were unsure.

The Academy, in cooperation with the American Academy of Family Physicians, and the American Academy of Otolaryngology, is developing a practice parameter on managing otitis media with effusion in young children.

Conducted by the AAP Department of Research, Periodic Survey #19 on Management of Otitis Media with Effusion received replies from 1,211 AAP members.