Updated practice guidelines for treatment of acute otitis media are being developed in response to practice changes concerning choice of antibiotic treatment and availability of the heptavalent pneumococcal conjugate vaccine (PCV7). In anticipation of these guidelines, Coker and colleagues conducted a meta-analysis of 135 articles in order to explore diagnosis and treatment of acute otitis media, as well as the effect of PCV7 on its microbial epidemiology.

The analysis included four studies showing that despite no accepted standard for diagnosing acute otitis media, diagnosis is usually based on three factors: evidence of acute infection, signs of middle ear inflammation, and effusion. However, studies showed that the most accurate diagnoses were associated with otoscopic examination revealing tympanic membrane bulging and redness. The authors suggest that training health care providers to accurately assess otoscopic examination results, instead of relying on presence of symptoms, may help to improve diagnosis of acute otitis media.

Of the 135 articles, 125 examined treatment. Immediate administration of ampicillin or amoxicillin for acute otitis media had a slight benefit over placebo or delayed antibiotics. Adverse effects associated with antibiotic treatment included diarrhea and rash. The authors note that health care providers should determine whether the benefits outweigh the risks before immediately prescribing antibiotics for acute otitis media. They also found amoxicillin to be equally as effective as more expensive medications.

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