Medical therapy of otitis media: use, abuse, efficacy, and morbidity.

Otitis media (OM) is one of the most common paediatric disorders encountered by primary care physicians. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the principal pathogens responsible for OM. As a result of the increasing prevalence of antimicrobial resistance, the use of antimicrobial therapy in OM has come under close scrutiny. Amoxicillin remains the most appropriate option for initial empiric therapy of acute otitis media (AOM). The duration of therapy required for AOM depends on the age of the patient, the severity of disease, and the route of administration. In most cases, particularly in children older than 5 years of age, a 5-day course of antibiotic therapy should suffice. Antibiotic therapy is not required in most cases of otitis media with effusion (OME) and should be reserved for those with bilateral effusions persisting for longer than 3 months associated with significant hearing loss. Antibiotic prophylaxis for recurrent AOM should be minimized. Myringotomy with or without tympanostomy tube placement is an important therapeutic option in those with OME and recurrent AOM. Active immunization against S. pneumoniae and Influenza A is likely to play an increasingly important role in the prevention of OM.