Scope and Target Population:

Children from birth to age 18.

Clinical Highlights and Recommendations:

1. Schedule an appointment for the child within 24 hours of the call to the clinic.
   
2. A clinical examination is necessary to diagnose acute otitis media. Diagnosis made over the phone is generally discouraged.
   
3. Educate parents on measures to prevent the occurrence of otitis media.
   
4. Prescribe first line antibiotics (amoxicillin) when the diagnosis of otitis media is made.
   
5. Prescribe second line antibiotics when the patient fails to respond to first line drugs, has a history or lack of response to first line drugs, is hypersensitive to first line medications, has a resistant organism as defined by culture, or has a coexisting illness requiring a second line medication.
   
6. Recheck in 3-4 weeks or at next well child visit (if within 4-6 weeks) for:
   
   • all children <5 years of age, and
     
   • those 5 years of age or older if risk factors are identified, there is a history of previous ventilation tubes or ear surgery, or if there is a history of speech or development delay
   
   
7. Refer the patient to an ENT physician when the criteria are met.

Priority Aims and Suggested Measures:

1. Increase appropriate antibiotic usage for otitis media infections.
   
2. Increase the timely and appropriate clinical follow-up for patients with a diagnosis of otitis media.
   
3. Improve parents' (caretakers') knowledge of symptoms suggestive of otitis media, appropriate indicators for a provider visit, risk factors, and outcomes of otitis media.

Additional Background:
Otitis media is the most frequent diagnosis made at visits to U.S. office-based physicians by children under the age of 15. Moreover, these office visits have shown a dramatic increase in recent years. It is estimated that 24.5 million visits to office-based physicians were made in 1990, a 150% increase over the number of visits in 1975 (AHCPR Publication #94-0620).