Who needs admission among infants with acute otitis media?

• Published in: Journal of paediatrics and child health 2012-05, Vol.48 (5), p.435-438
• Main Authors: Bitar, Mohamed A, Baz, Rami, Sabra, Omar
• Format: Article
• Language: English
• Subjects: Acute Disease; Age Factors; Anti-Bacterial Agents - therapeutic use; Babies; bacteriology; Ear diseases; Female; Hospitalization; Humans; Infant; Infant, Newborn; Male; neonate; otitis media; Otitis Media - complications; Otitis Media - microbiology; Otitis Media - therapy; Patient Admission - standards; Practice Guidelines as Topic; Retrospective Studies; Sepsis - complications; Sepsis - diagnosis; sepsis work-up
• ISSN: 1034-4810; 1440-1754
• DOI: 10.1111/j.1440-1754.2011.02249.x

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.