What is the main management approach for acute otitis media upon diagnosis?

In the management of acute otitis media (AOM) upon diagnosis, the primary approach is the administration of oral antibiotics. AOM is typically caused by bacterial infection, and well-established guidelines recommend starting antibiotics especially in certain affected populations, such as children under two years of age, children with severe symptoms, or when there is a clear diagnosis of AOM.

Antibiotics help to eliminate the bacterial infection responsible for pain and fever, thus alleviating symptoms and preventing potential complications, such as recurrent infections or more severe systemic effects. It’s important to recognize that antibiotics should be used judiciously — in some cases, especially in older children with mild symptoms, a strategy of observation might be appropriate, but if immediate treatment is necessary due to the severity of symptoms or the age of the patient, antibiotics are the treatment of choice.

Other management options such as monitoring without treatment may be considered for mild cases or in older children with good follow-up, but the immediate initiation of antibiotics is essential for cases that meet treatment criteria. The use of nasal decongestants or immediate ear tube insertion would not be standard initial management approaches for AOM; decongestants do not treat the underlying infection, and surgery is typically reserved for recurrent or complicated cases