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November 26, 1997

Short-Course Antimicrobial Treatment for Acute Otitis Media: Not Best for Infants and Young Children

Author Affiliations

From the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
Dr Paradise has received honoraria and research support from SmithKline Beecham Pharmaceuticals, Philadelphia, Pa, and Pfizer Inc, New York, NY, as well as consultation fees from SmithKline Beecham.

JAMA. 1997;278(20):1640-1642. doi:10.1001/jama.1997.03550200016006

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