Most general practitioners in Britain would treat a child with acute otitis media with antibiotics.1 However, papers published recently in the BMJ cast doubt on the effectiveness of this policy.2 3 The authors concluded that antibiotics offer only limited benefits and that most children with acute otitis media can be managed without them. If justified, the authors' conclusions would have important implications for British general practice. Acute otitis media is one of the commonest childhood problems seen by general practitioners. Every year, about 10% of under 5 year olds and 3.5% of 5-15 year olds are seen by their general practitioner at least once with the condition. Hence, a typical general practitioner will see about 20 children with acute otitis media every year.4 As there are more than 30 000 general practitioners in Britain, a more restricted role for antibiotics in the management of acute otitis media would lead to a substantial reduction in the prescribing of antibiotics. This in turn would result in fewer children experiencing the side effects of antibiotics and less likelihood of antibiotic resistance developing. The potential benefits of reduced antibiotic prescribing are clear, but …