IN RECENT years a number of authors—this author among them—have called for restricting, in varying degree, the use of antimicrobials in treating otitis media.1-5 Two factors have prompted these recommendations: compelling evidence that selective pressure from antimicrobial use contributes importantly to the rising prevalence of infections caused by multidrug resistant Streptococcus pneumoniae,6,7 and the fact that otitis media accounts for a large proportion of all antimicrobial use. For example, in 1986, of 44.5 million office-based prescriptions for antimicrobials for children younger than 10 years, 42% were for otitis media8; while in 1990,1 or more drugs—mainly antimicrobials—were prescribed at more than 80% of the estimated 24.5 million visits to physicians' offices for otitis media.9,10 Of those visits, children younger than 2 years accounted for 33.3%; children aged 2 to 5 years, 29.2%; and children aged 6 to 14 years, 17.9%.9 In a recent prospective study, antimicrobial
Paradise JL. Short-Course Antimicrobial Treatment for Acute Otitis Media: Not Best for Infants and Young Children. JAMA. 1997;278(20):1640–1642. doi:10.1001/jama.1997.03550200016006
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