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TABLE 4

Recommendations for Initial Management for Uncomplicated AOMa

AgeOtorrhea With AOMaUnilateral or Bilateral AOMa With Severe SymptomsbBilateral AOMa Without OtorrheaUnilateral AOMa Without Otorrhea
6 mo to 2 y Antibiotic therapy Antibiotic therapy Antibiotic therapy Antibiotic therapy or additional observation 
≥2 y Antibiotic therapy Antibiotic therapy Antibiotic therapy or additional observation Antibiotic therapy or additional observationc 
AgeOtorrhea With AOMaUnilateral or Bilateral AOMa With Severe SymptomsbBilateral AOMa Without OtorrheaUnilateral AOMa Without Otorrhea
6 mo to 2 y Antibiotic therapy Antibiotic therapy Antibiotic therapy Antibiotic therapy or additional observation 
≥2 y Antibiotic therapy Antibiotic therapy Antibiotic therapy or additional observation Antibiotic therapy or additional observationc 
a

Applies only to children with well-documented AOM with high certainty of diagnosis (see Diagnosis section).

b

A toxic-appearing child, persistent otalgia more than 48 h, temperature ≥39°C (102.2°F) in the past 48 h, or if there is uncertain access to follow-up after the visit.

c

This plan of initial management provides an opportunity for shared decision-making with the child’s family for those categories appropriate for additional observation. If observation is offered, a mechanism must be in place to ensure follow-up and begin antibiotics if the child worsens or fails to improve within 48 to 72 h of AOM onset.

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