Acute otitis media

At least 1 episode of acute otitis media is seen in 94% of children before age 2. Attendance in a day-care setting is among the major risk factors. Middle ear fluid may be sterile or may grow viruses and/or bacteria. Accurate diagnosis and distinction from otitis media with effusion is essential for proper management, but physicians often have difficulty in making the correct diagnosis. Since overuse of antibacterial agents contributes to an increase in bacterial resistance, physicians should consider delaying treatment for 2 to 3 days, during which therapy is aimed at controlling pain. High-dose amoxicillin is the preferred antibacterial agent in a young child with a purulent middle ear effusion, but amoxicillin-clavulanate, cefuroxime axetil, and ceftriaxone are options when resistant bacteria are. encountered.