Acute Otitis Media — Antibiotic or Observation (AAP 2013)
Applies the AAP 2013 initial-management rule for uncomplicated acute otitis media in children aged 6 months to 12 years (age, laterality, otorrhoea, severity), with NICE NG91 for UK practice.
Score interpretation
The AAP 2013 rule covers children aged 6 months to 12 years with uncomplicated AOM.
→ Under 6 months: same-day clinical assessment (NICE NG143: under 3 months with temperature 38 °C or higher is high risk). 13 years and older: NICE NG91 (under 18s) — no antibiotic or a back-up for most; immediate antibiotic if systemically very unwell, signs of a more serious illness or high risk of complications. Adults: Amoxicillin 500mg TDS 5 days. Children: use a children's formulary.
Non-severe unilateral AOM at 6–23 months, or non-severe AOM at 2 years or older, without otorrhoea (AAP 2013 3C/3D).
→ Analgesia (paracetamol, ibuprofen); either an antibiotic or observation for 48–72 h with a mechanism to start one if the child worsens or fails to improve (NICE NG91: no antibiotic or a back-up prescription).
Otorrhoea, severe signs or symptoms, or bilateral AOM under 24 months (AAP 2013 3A/3B and Table 4).
→ Prescribe an antibiotic — amoxicillin first line, co-amoxiclav if no response at 48–72 h (Children: use a children's formulary.); analgesia; ENT review and exclude mastoiditis (post-auricular swelling, protruding ear) if not improving.
Interpretation bands for the AOM Antibiotic Decision. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Amoxicillin (Otitis Media / Sinusitis) · Beta-lactam antibiotic
- Chloramphenicol Ear Drops · Topical Antibiotic — Otitis Externa
- Framycetin / Sofradex · Topical Antibiotic-Steroid — Otitis Externa
- Amoxicillin · Antibiotic (Penicillin)
- Amoxicillin · Beta-lactam antibiotic (aminopenicillin)
- Amoxicillin (Paediatric) · Aminopenicillin Antibiotic
- Adult Upper Airway Obstruction (Stridor) · DAS 2015 unanticipated difficult airway; RCEM
- Epistaxis Management · ENT-UK / NICE
- Acute Otitis Media · NICE NG91 2018
- Tonsillitis and Sore Throat · NICE NG84 2018
- Benign Paroxysmal Positional Vertigo · NICE CG124 / AAO-HNS Guidelines
- Acute Rhinosinusitis · NICE NG79 2017 / EPOS 2020
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.