1. Otitis media in patients who have severe otalgia, are seriously ill, or appear toxic
2. Unsatisfactory response to antimicrobial therapy
3. Onset of otitis media in a patient who is receiving antimicrobial therapy
4. Otitis media associated with a confirmed or potential suppu-rative complication
5. Otitis media in a newborn, sick neonate, or immunologically deficient patient, any of whom might harbor an unusual organism effusions resolve spontaneously during the 3 months after onset. There is a well-founded perception by authorities in the field that too many patients are receiving unnecessary amounts of antibiotics for this condition, which may be related to the growing resistance problem.12
Patients who still have a middle ear effusion present at the 4- to 6-week visit should be reevaluated 3 to 4 months after the onset of the infection; those without effusion at 4 to 6 weeks can be discharged. Management of persistent middle ear effusion is similar to that described below for patients who have otitis media with effusion.
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