Otitis media primarily affects children, but can also lead to lifelong sequelae. Middle ear histopathologic changes and clinical manifestations can represent any part of a disease continuum, from acute to recurrent to chronic otitis media. Acute otitis media is most often caused by an acute respiratory viral infection and secondary replication of bacteria in the middle ear space and tissues, leading to symptoms and signs of infection (ie, fever, pain, tympanic membrane erythema). Antimicrobial therapy is the mainstay of management, and clinical response to different antimicrobial drugs appears to be similar. The bacteriologic efficacy of these drugs, however, is quite variable. Clearly, antimicrobial treatment of acute otitis media, which currently is largely empiric, must be fine-tuned on the basis of patient and disease variation.