In summary, infants and children who have acute
otitis media should receive antimicrobial
therapy.
Amoxicillin is the standard of
therapy for infants and children with acute
otitis media, because it is safe and effective for most of the causative bacterial pathogens.
Amoxicillin has also been shown to be effective for treatment of selected children with
otitis media with effusion ("
secretory" otitis media) and is the recommended prophylactic
antimicrobial agent for prevention of frequently recurrent acute
otitis media. During the past decade, however, an increasing rate of bacteria that are resistant to
amoxicillin has occurred, primarily
beta-lactamase-producing H. influenzae and B. catarrhalis. Because of the emergence of these bacteria, other
antimicrobial agents, both old and new, have been advocated for treatment and prevention of
otitis media;
amoxicillin-
clavulanate,
cefuroxime axetil, and
cefixime are the newer agents. These agents are indicated for selected infants and children; however, for most patients,
amoxicillin remains a safe and relatively inexpensive effective
drug. The common
surgical procedures, such as myringotomy with
tympanostomy tube insertion, and
adenoidectomy with myringotomy with or without
tympanostomy tube insertion, have now been shown to be effective for patients who have recurrent acute
otitis media and chronic
otitis media with effusion. The decision for or against these procedures should not only include consultation with an otolaryngologist but should also involve the parents and the child, if old enough. The risks, costs, and benefits of nonsurgical and surgical management should be discussed with all parties concerned.