In the US this year, clinicians will write approximately 25 000 000 oral antibiotic prescriptions for acute otitis media (AOM). I thought it worthwhile to describe current management in the US, given how often clinicians diagnose AOM, the concern about appropriate use of oral antibiotics, and the European trend for not treating this condition with antibiotics. In 1999, the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group, sponsored by the Centers for Disease Control, published their recommendations regarding initial antibiotic choice for AOM.1 Essentially, they divide children into two categories, those who received antibiotics in the month before, and those who did not. Young age, daycare attendance, residence in certain communities, and previous treatment with oral antibiotics are major risk factors for resistant pneumococcal disease. For children who have not been on antibiotics the working group recommended high dose amoxicillin or usual dose amoxicillin. Children with clinically defined failure on day three should receive high dose amoxicillin-clavulanate, cefuroxime axetil, or intramuscular ceftriaxone. For children who have been on antibiotics in the previous month they recommended high dose amoxicillin, high dose amoxicillin-clavulanate, or cefuroxime axetil. If these children have clinical failure on day three, they should receive intramuscular ceftriaxone, clindamycin, or a tympanocentesis. Their recommendations were …