Reappraisal of management of acute otitis media is required

EDITOR—Majeed and Harris's editorial on the treatment of acute otitis media in children contains an intellectual non sequitur.1 While acknowledging that over three fifths of children are pain free at 24 hours and that serious complications are rare, they fail to appreciate the trade off between risk and benefit by endorsing the current practice of antibiotic prescribing.

To a concerned parent whose child has acute otitis media, information can be conveyed in these terms: over half of children with earache are pain free after 24 hours provided symptomatic treatment is given; and for every child who experiences diminished pain between two to seven days, three other children will have vomiting, diarrhoea, or a rash without deriving …