ABSTRACT
Of all community-acquired respiratory tract infections, otitis media remains the leading indication for antimicrobial therapy among children in the United States. The rate of prescribing declined remarkably during the 1990s, probably a result of broad-based efforts to improve the specificity of the diagnosis and to limit antimicrobial therapy to those patients who are likely to benefit from it. The recent past has also seen substantial changes in the antimicrobial susceptibility patterns of the leading agents-pneumococcus in particularand in the perception of the importance of viral agents. Clinicians caring for patients with otitis media now need to carefully consider such options as deferring antimicrobial treatment for many patients, prescribing a shortened course for some, and recommending topical therapy with newer agents for others. Many patients meeting diagnostic criteria for acute otitis media should still be treated with an appropriate course of an antimicrobial agent with efficacy against the major pathogens, although efforts are under way to promote watchful waiting for certain patients.
