Update on acute otitis media

The increase in drug-resistant Streptococcus pneumoniaehas led to concerns about antibiotic resistance. Otitis media is the leading indication for antibiotic use in the United States. Evidence suggests that antibiotics do provide benefit to children with documented acute otitis media, and that carefully selected children may respond to shorter courses of antibiotics. Despite the increase in resistance, amoxicillin remains the drug of choice for acute otitis media even in areas with high levels of resistance. Pneumococcal conjugate vaccine and live attenuated influenza vaccine, which may be licensed in the future, will both have an impact on acute otitis media. During the next few years, these vaccines, along with more stringent diagnostic criteria, and more judicious use of antibiotics, may all contribute towards reducing the incidence of acute otitis media, the number of antibiotic prescriptions given and the adverse impact of antimicrobial resistance.