The most common reason for antimicrobial use in United States children is treatment of otitis media. Of 44.5 million office-based prescriptions for antimicrobials in 1986 for children younger than than 10 years of age, 42% were for otitis media, and of the estimated 20 million visits in 1990 for otitis media by children younger than 14 years of age, antimicrobials were prescribed at >80%.In a recent prospective study, antimicrobial treatment of otitis media accounted for >90% of all antimicrobial use during the first 2 years of life.

Foundations for rational use of antimicrobials for acute otitis media (AOM) were first laid down in the United States in a series of five reports6-10  in Pediatrics over a 14-year period beginning in 1956. Each of the reports concerned the bacteriology of AOM as determined from aspiration and culture of middle ear exudate. Taken as a...

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