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In Reply I am in full agreement with Dr Del Mar and colleagues that accurate diagnosis is an essential component to endorsing the use of antibiotics for acute otitis media. If a child does not have acute otitis media in the first place, then no antibiotics are necessary. In the meta-analyses and reviews showing marginal benefits from antibiotics, it is likely that as many as half of the included patients did not have acute otitis media,1,2 thereby diluting the true benefit of antibiotics that occurred in the children who were correctly diagnosed.
Pichichero ME. Antibiotics for Children With Acute Otitis Media—Reply. JAMA. 2015;313(15):1575. doi:10.1001/jama.2015.3083