To Treat or Not to Treat

Rosenfeld’s recent commentary “Otitis, Antibiotics, and the Greater Good”1 focuses on the importance of the paradigm shift that lies at the core of the new American Academy of Pediatrics clinical practice guideline2 for acute otitis media (AOM). This paradigm shift, referred to as the observation option, allows selected children to receive analgesics rather than antibiotics in the first few days after diagnosing AOM in the hope that their infection will resolve spontaneously. It is important to emphasize that this option is intended for a very limited set of children, including only those at least 2 years of age with either nonsevere symptoms or an uncertain diagnosis of AOM.2 Some of the current literature3 regarding the utility of antibiotic therapy in AOM, including Rosenfeld’s commentary,1 reflects an increasingly popular view that is largely based on the results of several recently published meta-analyses.4–6 These meta-analyses are reported to support the conclusion that antibiotics exert only a modest benefit compared with placebo for children with AOM and that there has been no demonstrable superiority of any antibiotic compared with amoxicillin in the treatment of this condition.7 To appreciate the conclusion of these … Address correspondence to Ellen R. Wald, MD, Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3705 Fifth Ave, Pittsburgh, PA 15213. E-mail: ellen.wald{at}chp.edu