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Pediatr Infect Dis J. 2019 Dec;38(12S Suppl):S22-S36. doi: 10.1097/INF.0000000000002430.

Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Prevention.

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From the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric highly intensive care unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
Department of Human Health Sciences, University of Florence, AOU Firenze, Italy.
Department of Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy, Primary care paediatrician, Florence, Italy.
Primary care paediatrician, Milan, Italy.
Primary care paediatrician, Caserta, Italy.
Nurse, Novara, Italy.
Associazione Italiana Vie Aeree (AIVAS): Study Group on Respiratory Infections, Genoa, Italy.
Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Division of Pulmonology, Allergy, and Immunology, Pediatric Unit, AOU "Policlinico-Giovanni XXIII", Bari, Italy.



In recent years, new information has been acquired regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society, therefore, decided to issue an update to the Italian Pediatric Society guidelines published in 2010.


The search was conducted on Pubmed, and only those studies regarding the pediatric age alone, in English or Italian, published between January 1, 2010 and December 31, 2018, were included. Each study included in the review was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The quality of the systematic reviews was evaluated using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts.


The importance of eliminating risk factors (passive smoking, environmental pollution, use of pacifier, obesity, limitation of day-care center attendance) and the promotion of breastfeeding and hygiene practices (nasal lavages) was confirmed. The importance of pneumococcal vaccination in the prevention of AOM was reiterated with regard to the prevention of both the first episode of AOM and recurrences. Grommets can be inserted in selected cases of recurrent AOM that did not respond to all other prevention strategies. Antibiotic prophylaxis is not recommended for the prevention of recurrent AOM, except in certain carefully selected cases. The use of complementary therapies, probiotics, xylitol and vitamin D is not recommended.


The prevention of episodes of AOM requires the elimination of risk factors and pneumococcal and influenza vaccination. The use of other products such as probiotics and vitamin D is not supported by adequate evidence.

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