General practitioners want to know whether a treatment works and is safe in practice

Editor—Froom et al question the benefit of routine use of antimicrobials for acute otitis media.1 I agree with their arguments but believe that the inclusion solely of randomised double blind placebo controlled trials in their study is insufficient to make the point. Studies undertaken in tertiary care centres cannot dispel practitioners' doubts about the need for antibiotics in acute otitis media.

Observational studies that Bollag-Albrecht and …