Clinical recommendation	Evidence rating	References
Diagnosis of acute otitis media requires confirmation of acute onset, identification of signs of middle ear effusion, and evaluation for signs and symptoms of middle ear inflammation.	C	1
Antihistamines and decongestants should not be prescribed for children with acute otitis media or otitis media with effusion.	B	5, 22
Observation without antibiotic therapy is an option in selected children with acute otitis media.	B	1, 22
Amoxicillin at a dosage of 80 to 90 mg per kg per day should be the first-line antibiotic for most children with acute otitis media.	B	1
Patients with otitis media who fail to respond to the initial treatment option within 48 to 72 hours should be reassessed to confirm the diagnosis. If the diagnosis is confirmed, antibiotics should be started in patients for whom antibiotics were initially deferred, and a different antibiotic should be prescribed for patients already taking an antibiotic.	C	1