BACKGROUND. Acute otitis media (AOM) is a frequent cause of paediatric care and antibiotic prescription, affecting up to 75% of children under 5 years of age. Despite the available clinical guidelines, variations in its diagnosis and management persist.
OBJECTIVE. To synthesize current evidence on the treatment of childhood AOM, highlighting effective interventions and gaps in clinical knowledge.
MATRIAL AND METHODS. An umbrella review of systematic reviews and clinical guidelines published between 2000 and 2025 was conducted. PubMed, Cochrane Library, Virtual Health Library and Epistemonikos were consulted, following PRISMA criteria. We included studies in English (and Spanish in the case of local guides). Two review authors applied the inclusion criteria independently using Rayyan. Methodological quality was assessed with AMSTAR-2.
RESULTS. 33 studies were analysed. Eighteen reviews evaluated treatments (antibiotics, surgery, complementary therapies), five addressed prevention (vaccines, xylitol), and the rest epidemiological and implementation aspects. Short-acting antibiotics were as effective as longer-acting antibiotics, with fewer adverse effects. Pneumococcal vaccines significantly reduced the incidence. Xylitol showed moderate benefit. Amoxicillin remains a first-line treatment, with surveillance in mild cases. Gaps persist in the use of corticosteroids, education for caregivers, and monitoring of adverse effects.
CONCLUSION. There is strong evidence for the rational use of antibiotics and vaccines. However, more studies are needed on complementary interventions and strategies to improve adherence to clinical guidelines.
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