Since we were all once afflicted by Acute Otitis Media AOM, or have children in our extended fanilies prone to it, a review is timely.
A recent trial of antibiotics in high-risk Australian Aboriginal children with AOM is frightening in showig 50% failure rate compared to >90% cure rate in 8 previous comparable published trials about a decade earlier in Turkish, South African, French but especially American kids. Possibly the worse Australian result is because they were deprived kids from the outback, or that they were followedf or only 7 days whereas the earlier studies were mostly 30day cure rates.
But Wikipedia stresses the obvious, that the cause of AOM is mostly viral, and >80% will settle without antibiotics, ie antibiotics will appear to help only about half. So it is unclear what is the relevance for kids in other locales of such a trial in a high-risk minority Australian population.
The treatment of such acute upper respiratory infection should usually be based on prevention- for the sensitive, minimizing exposure to dairy and wheat products , pets, dust and pollen; chronic immune boosters regularly like fish oil 800mg omega3/d; buffered oral vit C to tolerance; vits b-carotene eg 100iu/kg/d plus zinc eg 0.4mg/kg/d plus vitamin D3 perhaps 100iu/kg/day; sniffing/spraying vitamin C powder up the nostrils twice a day; and a moderate dose of mucolytic eg acetylcysteine plus guai;
and for acute attacks, perhaps quadruple the mucolytics, plus 10fold higher vitamin D3 for a few days plus vit C increased to tolerance, plus oral colloidal silver plus steaming; and some probiotic. Vitamin C is usually tolerated at far higher dose during illness before the diarrhoea threshold is reached- the body seems to absorb and utilize far more.
However in litigious America with antibiotic-promoting Big Pharma, and compensation-mongering legal vultures, and resistant microorganisms, all proliferating like plague, an American viewpoint has to be heeded as in emedicine, that a judicious short sharp antibiotic policy may be justifiable self-defense prescription; rather than the doctor being accused of antibiotic omission in the perhaps 10 to 20% of new AOM cases that do not resolve without antibiotics.