Acute otitis media is a common health problem worldwide that accounts for significant morbidity, primarily among pre-school-age children, for which antimicrobial therapy is currently the treatment of choice. Approximately 25% of all prescriptions written in the US for children under the age of 10 years are for children diagnosed as having acute otitis media. Until adequately designed studies with appropriate patient populations are conducted, clinicians must base their decisions to treat acute otitis media with antimicrobial therapy, and their choice of drug, on local susceptibility patterns (if known), in vitro and in vivo studies, adverse effect profiles, tolerability, and affordability. Such studies will hopefully answer questions about selecting an antimicrobial for acute otitis media and address the comprehensive cost of using various antimicrobials for the condition. Because of the human and economic costs associated with acute otitis media, healthcare practitioners should also be aware of the epidemiology, pathophysiology and various treatment options for children with acute otitis media.