Nicole Le Saux and associates1 report that amoxicillin is superior to placebo in relieving effusion and symptoms of acute otitis media and review the current controversy surrounding the “do not treat” philosophy.
I believe that the problem lies with the diagnosis. We physicians have become too inclusive in our diagnosis of “acute” — that is, bacterial — otitis media. Including patients with non-infected effusion under the umbrella of acute otitis media has led to overtreatment. The number of patients with actual signs or symptoms of acute inflammation in the ear is actually quite low. I recently had the opportunity to confirm this in a survey of Manitoba pediatricians, family physicians, emergency physicians and otolaryngologists (unpublished data). No wonder some authors find that treatment is not effective.
Footnotes
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Competing interests: None declared.
Reference
- 1.