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What is already known on this topic? Acute otitis media (AOM) is a common childhood disease, which creates a major healthcare and economic burden.
In developed and developing countries, national guidelines and consensus papers address AOM diagnostic and therapeutic issues in order to reduce overdiagnosis and overtreatment.
There is a huge diversity of AOM diagnosis and management guidelines.
What this study adds? AOM guidelines from developed and developing countries have more similarities than differences.
Introduction
Acute otitis media (AOM) is one of the most common childhood diseases, representing the most common indication for antibiotic prescription and outpatient visits in children in the USA and other countries. 1-5 AOM is a substantial cause of health services use (office visits, antibiotic costs), potential complications (ie, acute mastoiditis, meningitis) and indirect costs (ie, absence from school or work). Reduced susceptibility to antibiotics among bacteria commonly causing AOM is also a major concern. 6 7 In order to reduce the burden of AOM and limit antibiotic prescriptions, various professional guidelines and consensus statements have been published. These position papers were created in order to assist physicians to accurately diagnose AOM and offer treatment options, reduce risk factors and encourage vaccination.
The first AOM management guidelines were published in the Netherlands in 1989. 8 The guidelines were drafted following the studies of van Buchem et al , 9 10 who opposed the traditional approach of antibiotic therapy administration to all children presenting with AOM, and offered a 'watchful waiting' approach in selected scenarios. The Dutch guidelines were aimed at general practitioners, who treat the majority of children with AOM.
Many countries followed the innovative Dutch practice and published their own guidelines based on local epidemiology data and accessibility to healthcare facilities. A few guidelines were revised, following changes in the epidemiology, antibiotic susceptibility of pathogens and implementation of preventive interventions, such as vaccines. These guidelines and consensus statements differ in various aspects, such as the methodology of AOM diagnosis, age range included; times when antibiotic therapy can be withheld; the types of antibiotic therapy, dosage and duration; and the option for additional therapy ( table 1 ). When comparing the content of some guidelines with others, there are even some conflicting statements. To date, there are no papers that reviewed...