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Int J Pediatr Otorhinolaryngol. 2014 Jul;78(7):983-4. Epub 2014 May 25.

To give or not to give antibiotics in non-severe acute otitis media? The American Academy of Pediatrics guidelines that do not guide.



To assess whether the recently published guidelines of the American Academy of Pediatrics (AAP) on acute otitis media (AOM) are in line with the requirements set by the GRADE system (grading of recommendations assessment, development, and evaluation system of rating quality of evidence and grading strength of recommendations in systematic reviews, health technology assessments, and clinical practice guidelines) and to compare them with the most recently published related guidelines (Korean and Japanese).


The AAP guidelines fail to answer the simple and explicit fundamental question on pediatric AOM management: whether antibiotics should be prescribed or not in non-severe AOM. Instead of giving a type C recommendation (option) if the available evidence was considered as inadequate or even a type D (no recommendation) the AAP guideline is to prescribe antibiotics or offer a watchful waiting for 48-72 h (strength of recommendation type B). This is in sharp contrast with the most recent guidelines (Korean and Japanese) that both recommend watchful waiting for 48-72 h (with the highest strength of recommendation - type A).


The AAP guidelines do not seem to be in line with the GRADE system as in an important, simple, and explicit question on: antibiotic administration in non- severe AOM, given in an ambiguous statement. This statement is in reality a vicious circle as the guidelines avoid to take any side and do not even categorize the answer as an option.

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