The long-term effects of direct amoxicillin in acute otitis media

We read with interest the report by Shaikh et al1 regarding the most cost-effective strategy for the management of children less than 2 years of age with acute otitis media (AOM) and no recent antibiotic exposure. According to their analysis this is immediate amoxicillin therapy. We value their well-conducted analysis in which they weighed many different factors. The editorial by Harrison shares this opinion and states that the study supports the American guidelines on AOM. However, we feel that some long-term effects have been given too little attention.

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