Abstract Damoiseaux RAMJ, Venekamp RP, Eekhof JAH, Bennebroek Gravenhorst FM, Schoch AG, Burgers JS, Bouma M, Wittenberg J. NHG-Guideline Acute otitis media in children (third revision). Huisarts Wet 2014;57(12):648. The Dutch College of General Practitioners (NHG) has revised the 2006 guideline Acute otitis media in children. The revised guideline covers the diagnosis and management of acute otitis media (AOM) in patients aged 0-18 years. Acute otitis media is a common condition, and an estimated 50–75% of the general population will have had AOM at least once in their lifetime, generally in early childhood. The condition generally has a favourable natural course: the most severe symptoms resolve without antibiotics within 2–3 days in more than 80% of children. However, pain and fever will probably last longer in children younger than 2 years with bilateral AOM. The diagnosis is based on the patient history (ear ache and/or illness) and otoscopy findings (., red, bulging, translucent tympanic membrane or otorrhoea). Adequate pain management is a key component in the management of AOM. Paracetamol is the first-choice painkiller, but ibuprofen can be given if paracetamol is not effective. In general, antibiotics do not alter the duration or severity of symptoms, but oral antibiotics should be prescribed for children at risk of complications (., children younger than 6 months) and children with AOM and severe general illness. Oral antibiotics can be considered for children younger than 2 years with bilateral AOM and children with AOM and acute otorrhoea through a perforation of the tympanic membrane and pain and/or fever. Watchful waiting is appropriate for most other children with mild disease. Oral antibiotics should be considered if symptoms have not improved after 3 days of adequate pain management. Acute otorrhoea in children with tympanostomy tubes should be treated with antibiotic/steroid eardrops. Children with acute otorrhoea through a perforation managed with watchful waiting should be prescribed oral antibiotics or antibiotic/steroid eardrops if otorrhoea persists after 1 week. Amoxicillin is the first-choice oral antibiotic, with co-trimoxazole being the alternative if there are contraindications for amoxicillin. Macrolide antibiotics should not be prescribed. If symptoms do not improve within 48 hours, then amoxicillin/clavulanic acid should be prescribed or the child referred to an ear-nose-throat (ENT) doctor. Children younger than 1 month, very ill children, and children with suspected meningitis should be referred to a paediatrician and children with suspected mastoiditis to an ENT doctor. An ENT doctor should be consulted, or the child referred, if antibiotic treatment is not effective or if the perforation of the tympanic membrane does not heal within 6 weeks.
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