BACKGROUND
Acute otitis media is very common, but diagnostic criteria and treatment recommendations vary considerably.
METHODS
Medline, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched using the key words 'acute otitis media' AND 'diagnosis' OR 'diagnostic criteria' OR 'definition', and by combining the terms 'acute otitis media' AND 'guidelines'. PubMed was searched using the key words 'mastoiditis' and 'prevalence'.
RESULTS
The 11 most recently published guidelines unanimously agreed that adequate analgesia should be prescribed in all cases. The majority recommended that routine antibiotic prescription should be avoided in mild to moderate cases and when there was diagnostic uncertainty in patients two years and older. Antibiotics were recommended in children two years and younger, most commonly a 5-day course of amoxicillin (or a macrolide in patients allergic to penicillin).
CONCLUSION
Level 1A evidence shows that selected cases of acute otitis media benefit from antibiotic prescription.