Managing otitis media: a time for change.

Given the increasing prevalence of multiply resistant pneumococcal infection and the heightened risks associated with antimicrobial usage, antimicrobial treatment of otitis media in children should be restricted generally to the extent possible without compromising individual children's well-being and without subjecting them to risks potentially greater than the risks associated with antimicrobial usage. Not infrequently the decisions required will be difficult and matters of judgment. However, in most cases the indications for initiating or prolonging antimicrobial treatment will be either straightforward, calling for a decision to proceed, or marginal, in which case the decision not to proceed should be clear.