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The principle of delayed antibiotic treatment for uncomplicated otitis media is now catching on fast. Uncomplicated otitis media should be defined as that occurring in a child older than two years of age, who does not have severe pain, is not sick or toxic looking, does not have an ear discharge and has no chronic underlying disease. Even if the child presents with a bulging pus-filled middle ear, use of acetaminophen or ibuprofen alone for the first few days may be successful in diminishing the symptoms. As long as the child remains asymptomatic despite the findings of a red and bulging, eardrum no antibiotic treatment is necessary provided good follow up care is available. The child should be seen regularly at one monthly intervals in order to document the expected resolution of the middle ear fluid, which will occur in 90% of cases within 3 months. If after three months from the initial presentation, the child still has fluid in the middle ear, a hearing test should be scheduled , a short 5-7 day course of antibiotics administered and a referral made to an Otolaryngologist . The most important recent advance in the management of acute otitis media has been the principle of delayed use or avoidance of antibiotic use in low risk children. Reference: 1.Grol R, Thomas S, Roberts R. Development and implementation of guidelines for family practice: Lessons from the Netherlands. J Fam Pract 1995; 40:435-439. 2. Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz B. Otitis media- principles of judicious use of antimicrobial agents. Pediatrics 1998; 101:165-171
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