[Acute otitis media: do not hesitate to treat].

Recently, two randomised, double-blind, placebo-controlled trials published in The New England Journal of Medicine have stirred up discussion about the use of antibiotics in the treatment of acute otitis media (AOM). In the Netherlands, the practice guideline of the Dutch College of General Practitioners recommends withholding antibiotics in most cases and that antibiotics can be considered when a child under the age of 2 years has bilateral AOM, otorrhoea, or persistent symptoms for 3 days or more. These recommendations are mostly based on a meta-analysis published in 2006. Previous studies on AOM had important limitations such as varying diagnostic criteria and biased patient selection. The new trials, which are of high methodological quality, investigated only 'real' AOM and the results show the same efficacy as the aforementioned meta-analysis. We therefore feel it is justified to consider prescribing antibiotics for a young child with manifest symptoms and evident AOM on otoscopic examination.