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September 13, 2006

Delayed Prescribing—A Sensible Approach to the Management of Acute Otitis Media

JAMA. 2006;296(10):1290-1291. doi:10.1001/jama.296.10.1290

Based on experience in Holland,1 evidence from systematic reviews,2 and recent evidence in the United Kingdom,3 many northern European countries, including the United Kingdom, have developed guidelines to advise physicians to delay for a short time before prescribing antibiotics for children with acute otitis media (AOM).4 The Dutch developed a policy of no prescription for AOM unless the patient has significant otalgia, fever, or both 72 hours after seeing the physician, or if a prolonged otic discharge develops.5 One study showed that if this watchful-waiting approach is used, there are likely to be few cases of complications (only 1 case of mastoiditis occurred in a 5000-patient cohort, and this patient had waited nearly a week).1 Patients and their families should be given clear advice about returning to see their physician if signs of complications occur, ie, worsening systemic features such as fever or vomiting.

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