Diagnosis and treatment of acute otitis media: evaluating the evidence.

Acute otitis media (AOM) is one of the most common illnesses for which children in the United States receive an antimicrobial agent. Of the six recommendations offered in recent guidelines for treatment of AOM, only one, the assessment and treatment of pain with analgesics, is based on strong evidence. This article reviews the diagnosis of AOM and the accuracy of various signs and symptoms in indicating a bacterial origin, the data on the effect of antimicrobial agents compared with placebo in the treatment of AOM, and the gaps in knowledge that should be addressed by future research and clinical trials.