The treatment for pediatric otalgia, particularly in the context of acute otitis media (AOM), involves both analgesic and antibiotic therapy, depending on the severity and age of the patient.
Analgesic therapy
- Assessment and treatment of pain: The American Academy of Family Physicians and American Academy of Pediatrics (AAFP/AAP) 2013 guidelines recommend assessing for pain as part of the management of AOM and offering analgesic treatment if present
- Ibuprofen or acetaminophen: The Italian Society of Pediatrics (ISP) 2019 guidelines recommend administering adequate doses of ibuprofen or acetaminophen for the treatment of otalgia in patients with AOM
Antibiotic therapy
- Young children (6 months to 2 years): The AAFP/AAP 2013 guidelines recommend initiating antibiotic therapy in patients aged 6–23 months with bilateral AOM, regardless of symptom severity . The ISP 2019 guidelines also recommend initiating antibiotic therapy in patients aged 6 months to 2 years with any form of unilateral or bilateral AOM, whether mild or severe
- Older children (>2 years): For patients older than 2 years, the ISP 2019 guidelines suggest a watchful waiting approach on a case-by-case basis in patients with mild or severe unilateral AOM or mild bilateral AOM, if follow-up is possible within 48–72 hours . The AAFP/AAP 2013 guidelines also recommend initiating antibiotic therapy, or offering observation with close follow-up based on joint decision-making with the parent or caregiver, in patients ≥24 months old with AOM without severe signs or symptoms
Topical antibiotics
- Not recommended: The ISP 2019 guidelines recommend not using topical antibiotics (with or without corticosteroids) except in patients with tympanostomy tubes
Effective management of pediatric otalgia involves prompt assessment and treatment of pain with appropriate analgesics such as ibuprofen or acetaminophen. Antibiotic therapy should be considered based on the child's age and the severity of symptoms, with a more aggressive approach in younger children and consideration of watchful waiting in older children when appropriate. Topical antibiotics are generally not recommended except in specific cases such as children with tympanostomy tubes.