[Acute otitis media--rational antibiotic treatment].

Acute otitis media is the most common reason for which antibiotics are prescribed to children. Because use of antibiotics has been implicated in the selection and progression of resistance among upper respiratory tract pathogens a concerted effort has been established to promote their judicious use. To reduce use of antibiotics recently published guidelines recommend observation option (watchful waiting) to children >2 years of age and non severe illness. Amoxicillin at conventional or high-doses remains an appropriate choice for first-line therapy. Appropriate options for second-line therapy include high-dose amoxicillin/clavulanate and ceftriaxon. Tympanocentesis is useful for identifying causative pathogen and may be beneficial for those who have failed second-line therapy. Natural history of untreated otitis media, most common pathogens and their resistance pattern are presented in the paper.