Acute otitis media in children is importan

EDITOR—Cates's paper made the point that children with acute otitis media who are not particularly ill often get better quickly; they may be managed with analgesics and a deferred prescription for an antibiotic, which is not always redeemed.1 Unfortunately, the content of the paper did little to justify its title. Nowhere does Cates make any reference to the diagnostic criteria for otitis media in children or specify whether the same diagnostic criteria were used in both his practice and the control practice—surely the essence of a control group. We are not even told the age range of the children.

The notion of reducing antibiotic use in children with acute otitis media is not at all evidence based; indeed, the evidence is highly controversial if strict criteria for the diagnosis are upheld. This has been the subject of several meta-analyses, which have universally shown a positive if marginal advantage for the use of antibiotics in the primary management of children with acute otitis media.2 …