Current therapy for otitis media and criteria for evaluation of new antimicrobial agents.

Otitis media is the most commonly diagnosed disease in infants and children in the United States. For routine empirical treatment of uncomplicated acute otitis media, amoxicillin is the drug of choice. Persistence of signs and symptoms of infection during antimicrobial therapy calls for a change to an antibiotic effective against beta-lactamase-producing bacteria (e.g., trimethoprim-sulfamethoxazole, amoxicillin/clavulanate, or one of the newer oral cephalosporins) or performance of tympanocentesis/myringotomy or both. The most common nonsurgical and surgical methods currently employed for prevention of frequent recurrences are antimicrobial prophylaxis, myringotomy with insertion of a tympanostomy tube, and adenoidectomy. For patients who have otitis media with effusion for which treatment is indicated, antimicrobial agents have been shown to be effective; amoxicillin is preferred as initial therapy. Guidelines for evaluating new antimicrobial agents in the treatment of otitis media are presented in this report.