Do we need to treat otitis media?

Otitis media is a common pediatric problem. It is well established that over half of infants and children with acute otitis media may have spontaneous recovery. Since it is difficult to predict the course (self-limited versus serious disease) all the children with acute suppurative otitis media need to be treated with antibiotics. Amoxicillin is still the initial antibiotic of choice. There are several alternate antibiotics available with activity against beta-lactamase positive bacteria. These agents have no advantage over amoxicillin in infections due to penicillin resistant pneumococci. Recent use of beta-lactam antibiotics and/or attendance in a day care where there is frequent use of antibiotics are predisposing factors for penicillin resistant pneumococcal infection. In such cases after tympanocentesis, higher dose of amoxicillin, clindamycin or intramuscular ceftriaxone should be considered. Secretory otitis media does not need to be treated with antibiotics unless the patient is in high risk group. Prophylactic use of antibiotics should be actively discouraged. Influenza and pneumococcal vaccination (2 years or older) should be encouraged in children with recurrent episodes of acute otitis media. Breast feeding should be encouraged.