Challenges in the management of otitis media

Acute otitis media (AOM) and otitis media with effusion are among the most common illnesses in children, and AOM is the most frequent diagnosis for wh ich oral antimicrobial agents are prescribed, Almost two thirds of children experience at least 1 episode of AOM by 1 year of age. Unfortunately, curr ent management of otitis media is associated with frequent relapses and per sistent middle ear effusion. Rn important element in improving response rat es is a better understanding of the disease pathophysiology. Age at: first episode is a critical determinant of recurrences, with those whose first ep isode occurs in the first 6 months of life being most likely to have subseq uent episodes. A number of other risk factors are associated with recurrent AOM, including family history, male gender, exposure to cigarette smoke, a nd day care attendance. One of the keys to successful management of the dis ease is to identify infants at high risk for persistent disease and to trea t them aggressively to prevent recurrent episodes. Amoxicillin remains an i mportant first-line treatment for AOM, and in communities with high inciden ces of penicillin-resistant strains of pneumococci, high-dose amoxicillin i s recommended.