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In Reply: Most of the studies cited by Dr Jackson and colleagues and by Drs Mascitelli and Pezzetta as indicating limited effectiveness of antibiotic treatment for AOM had one or more major limitations, each of which would militate against showing differences between treatment regimens. The limitations include limited sample size and statistical power, exclusion of children who seemed ill, enrollment of few or no children younger than 2 years, lack of standardized or stringent criteria for diagnosing AOM or for defining improvement or cure, use of an antimicrobial with less than optimal efficacy against common middle ear pathogens, and use of lower than optimal drug dosage.

These limitations notwithstanding, several of the investigators reported clinically important outcome differences favoring antibiotic-treated children over controls. For example, the report cited by Mascitelli and Pezzetta describes "significantly fewer days of discharge, less paracetamol consumption, fewer days when the child was reported as crying, . . . [Full Text of this Article]

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