A child with earache. Are antibiotics the best treatment?

BACKGROUND: Conventional management of acute otitis media, deduced from pathophysiology, embodies scant regard to analgesia, but concentrates on the microbiological cure by the use of antibiotics. OBJECTIVE: A commonly encountered case of uncomplicated acute otitis media in a child of three is presented. An evidence based approach to management is offered. RESULTS: The search for empirical evidence of patient relevant benefits and harms challenges the conventional approach. A Cochrane review of the literature on the use of antibiotics for acute otitis media shows that the benefits of antibiotic use (reduced pain in those children who go on to suffer pain beyond 24 hours) are offset by adverse events from the antibiotics themselves (gastrointestinal symptoms and rashes). There is insufficient information to be sure about rare complications of not using antibiotics as well using them, but it seems that in either case, catastrophe is very rare. DISCUSSION: Thinking in terms of a balance of harms and benefits would result in a decreased proportion of children prescribed antibiotics for acute otitis media.