Routine Antimicrobial Treatment of Acute Otitis Media

EVIDENCE THAT routine antimicrobial treatment improves the course and outcomes after acute otitis media is weak. Given the lack of evidence for benefit and the potential for adverse effects, including altering normal respiratory flora and development of resistant organisms, routine treatment using 10 days of antimicrobials for all cases of acute otitis media is not warranted. See also p 1640. There have been 7 randomized, blinded, placebo-controlled trials of acute otitis media over the past 30 years. Neither short- nor long-term differences were demonstrated in 3,1-3and minor differences noted in the other 4 studies were limited to short-term benefits of antimicrobials.4-7In a study by Howie and Ploussard,4all case patients receiving placebo were asymptomatic at early follow-up (2 to 7 days) but had more positive tympanocentesis cultures than those receiving antimicrobials. Mygind et al5found decreased pain in the penicillin group compared with the