Not all bacterial infections need an antibiotic.  It may sound hard to believe, but if we all followed the AAP guidelines on the management of otitis media in children and actually used a watch-and-wait approach in appropriate patients, upwards of 75% of the antibiotics prescribed for otitis media could be avoided.  Why? Because the microbiology of AOM has changed, but our prescribing practices haven't.  This episode is a great guideline refresher and microbiology update while learning how to talk parents into partnership on watchful waiting.   

References:

American Academy of Pediatrics. (2019). Chapter quality network improving antibiotic prescribing for children: Change package. Retrieved from https://downloads.aap.org/DOCCSA/CQN%20ABX%20Change%20Package%20Final%20October%202019.pdf

Frost, H. M., & Hersh, A. L. (2022). Rethinking Our Approach to Management of Acute Otitis Media. JAMA pediatrics, 176(5), 439–440. https://doi.org/10.1001/jamapediatrics.2021.6575

Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., Joffe, M. D., Miller, D. T., Rosenfeld, R. M., Sevilla, X. D., Schwartz, R. H., Thomas, P. A., & Tunkel, D. E. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964–e999. https://doi.org/10.1542/peds.2012-3488

Sanchez, G.V., Fleming-Dutra, K.E., Roberts, R.M., & Hicks, L.A. (2016). Core elements of outpatient antibiotic stewardship. MMRW Recomm Rep., 65(6), p. 1-12. doi: 10.15585/mmrw.rr.6506a1

Smolinski, N. E., Antonelli, P. J., & Winterstein, A. G. (2022). Watchful Waiting for Acute Otitis Media. Pediatrics, 150(1), e2021055613. https://doi.org/10.1542/peds.2021-055613

Sun, D., McCarthy, T. J., & Liberman, D. B. (2017). Cost-Effectiveness of Watchful Waiting in Acute Otitis Media. Pediatrics, 139(4), e20163086. https://doi.org/10.1542/peds.2016-3086

Venekamp, R. P., Sanders, S. L., Glasziou, P. P., Del Mar, C. B., & Rovers, M. M. (2015). Antibiotics for acute otitis media in children. The Cochrane database of systematic reviews, 2015(6), CD000219. https://doi.org/10.1002/14651858.CD000219.pub4