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To the Editor: Dr Spiro and colleagues¹ reported the results of a trial of "wait-and-see prescription" (WASP) for treatment of acute otitis media. In an accompanying editorial, Dr Little² stated that it would be unwise to use the WASP approach to antimicrobial therapy if a child with acute otitis media has already had high fever and severe otalgia for more than 72 hours.

However, Spiro et al did not use these as exclusionary criteria; in their study, patients were excluded only if they appeared "toxic," not based on height of fever or pretherapy symptom duration and severity. Little's implicit assumption that the subgroup identified by his criteria would fare poorly with expectant management, which may be correct, could be substantiated from Spiro et al if such patients were studied and they either (1) always had the prescription filled when randomized to the WASP group or (2) had significantly worse outcomes . . . [Full Text of this Article]

James R. Johnson, MD
johns007@umn.edu
VA Medical Center
Minneapolis, Minn

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