I have been told that pediatricians now state that most cases of otitis media in children are viral in origin and do not require antibiotic treatment. If this is true, what treatment do you recommend? Watch and wait? Does the same approach apply to adults?—JOSEPH CAMIRE, DO, West Plains, Mo.

You have been told correctly. In 2004, the American Academy of Pediatrics and the American Academy of Family Physicians published joint clinical practice guidelines for the diagnosis and management of acute otitis media (Pediatrics. 2004;113:1451-1465). The recommended treatment for children older than age two years is pain management and observation (unless the patient is severely ill). Such oral analgesics as acetaminophen or ibuprofen are most effective. A topical anesthetic like benzocaine is another option and can be used alone or in conjunction with oral analgesics.—Julee B. Waldrop, MS, PNP (139-4)