There is a high rate of use of antimicrobial drugs for otitis media in children. This article reviews the diagnostic considerations for acute otitis media. An extensive review of literature on this subject has been carried out in order to address the issues of indications, choice, appropriate doses of antimicrobial agents and the duration for which they should be used. It is important to distinguish acute otitis media from otitis media with effusion because antibiotics are seldom indicated for the latter condition. Oral amoxicillin remains first-line therapy for uncomplicated acute otitis media, a short course of antimicrobial therapy (five to seven days) may be appropriate in children two years of age or older with uncomplicated presentations. For clinical treatment failures after 3 days of amoxicillin, recommended antimicrobial agents include oral amoxicillin/clavulanate, cefuroxime axetil, cefprozil, cefpodoxime proxetil, and intramuscular (i.m.) ceftriaxone. Tympanocentesis for identification of pathogens and susceptibility to antimicrobial agents is recommended for selection of third-line agents.