Wait and See Antibiotic Prescription for Acute Otitis Media: A Randomized Controlled Trial

We conducted a randomized, controlled trial evaluating a consecutive series of children diagnosed with AOM during a one year period in an urban pediatric emergency department, utilizing diagnostic recommendations from contemporary evidence-based guidelines. The objectives of the study were to determine whether treatment of AOM using a "Wait and See Prescription" (WASP) significantly reduces use of antimicrobials compared with a "Standard Prescription" (SP) and to evaluate the effects of this intervention on clinical symptoms and adverse outcomes related to antibiotic use.

Inclusion criteria

• Children between the ages of 6 months - 12 years who were diagnosed with Acute Otitis Media

Exclusion criteria

• clinician suspicion or diagnosis of a concurrent bacterial infection
• patient appeared "toxic" as determined by the PEM clinician
• patient was hospitalized
• history of compromised immunity
• patient was treated with antimicrobials in the preceding seven days
• either tympanic membrane was perforated
• myringotomy tubes were present
• uncertain access to medical care
• primary language of the parent or guardian was neither English nor Spanish
• prior enrollment in the study