Table 2

Indications for consideration of immediate antibiotic treatment in European and AAP guidelines

GuidelineAge (months)*Parental input†Unilateral AOM‡Bilateral AOM aged <24 months§Severe symptoms¶Co-morbiditiesRecurrent AOMTM perforation/otorrhoea
Italy++++
Spain<24++++
Denmark<6+++
France<24++
Portugal<6++++
USA++++
Norway<12++
Poland<6+++++++
Belgium<6++++
Czech Republic++
Finland<24++
Germany<24+++++
Ireland+
Luxembourg<24+
The Netherlands<6++++
Sweden<12++++
Switzerland<24+++++
UK
Legend
Highest grade
Moderate grade
No grade
  • ‘–’ indicates that those indications are not mentioned in the guideline.

  • Note: There is no ‘Lowest grade’ in this table.

  • *Sweden: also children aged >12 years. Switzerland: <24 months of age, only if the child appears unwell.

  • †France: give antibiotics if parents are considered unreliable. USA: joint decision-making with parents at any age. Poland: joint decision-making with parents if child is <24 months of age.

  • ‡Unilateral: Italy: if age <6 months. Poland: if age <24 months, then can give after joint decision-making with parents.

  • §Belgium, Finland and Sweden: bilateral at any age. Luxembourg: after consultation with parents.

  • ¶Symptoms include fever, otalgia, pain, vomiting and diarrhoea. Switzerland: only if <24 months old.

  • AAP, American Association of Pediatrics; AOM, acute otitis media; TM, tympanic membrane.