An international group of multidisciplinary experts on middle-ear and paediatric
infections met to explore where consensus exists on the management of acute
otitis media. After informal discussions among several specialists of paediatric
infectious disease, the group was expanded to include a larger spectrum of professionals with complementary expertise in middle-ear disease. Acute
otitis media is a very common
bacterial infection in children worldwide, leading to excessive
antibiotic consumption in children in most countries and to a substantial burden of
deafness and suppurative complications in developing countries. The group attempted to move beyond the existing controversies surrounding guidelines on acute
otitis media, and to propose to clinicians and public health officials their views on the actions needed to be taken to reduce the disease burden caused by acute
otitis media and the microbial antibiotic resistance from the resulting use of
antibiotics. Definition of acute
otitis media and diagnostic accuracy are crucial steps to identify children who will potentially benefit from treatment with
antibiotics and to eliminate unnecessary prescribing. Although the group agreed that
antibiotics are distributed indiscriminately, even to children who do not seem to have the disease, no consensus could be reached on whether
antibiotics should be given to all appropriately diagnosed children, reflecting the wide range of practices and lack of convincing evidence from observational studies. The major unanimous concern was an urgent need to reduce unnecessary prescribing of
antibiotics to prevent further increases in antibiotic resistance. Prevention of acute
otitis media with existing and future viral and
bacterial vaccines seems the most promising approach to affect disease burden and consequences, both in developed and developing countries.