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J Paediatr Child Health. 2012 May;48(5):435-8. doi: 10.1111/j.1440-1754.2011.02249.x. Epub 2011 Nov 23.

Who needs admission among infants with acute otitis media?

Author information

  • 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut School of Medicine and Medical Center, Beirut, Lebanon. mb36@aub.edu.lb

Abstract

AIM:

Management of acute otitis media (AOM) in infants younger than 2 months old is controversial. It varies between treatment on an outside basis, and hospitalization for intravenous antibiotics and sepsis work-up based on variability of the reported AOM pathogens in this particular group. Our aim is to identify clinical indicators that may suggest a need for an invasive medical work-up and/or hospitalization of these young patients, and compare their management to that of older infants.

METHODS:

Retrospective chart review. Admitted infants with AOM and a random sample of infants presenting to the emergency room with AOM over a 20-year period. Infants younger than 2 months were designated as 'young infants', and those older as 'older infants'. Demographic data, relevant history, physical examination, laboratory studies and treatment were reviewed.

RESULTS:

Twenty-nine admitted infants were included (13 young infants). A sample of 58 outpatients was studied, including two young infants. Compared to older inpatient infants, admitted young infants were less febrile (P < 0.05), had more benign white cell count (P < 0.05) but had more otorrhea (P < 0.05). These grew gram-negative organisms. Sepsis work-up was negative. Young infants were more likely to be admitted (P < 0.05). Admitted older infants had more otorrhea than outpatients (P < 0.05) or a complication (P < 0.05).

CONCLUSIONS:

Young infants often need admission for intravenous antibiotics, until middle ear culture is out. Sepsis work-up may be necessary only in toxic patients. Older infants need admission when severely ill or have a complication.

© 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

PMID:
22107109
[PubMed - indexed for MEDLINE]
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