The emergence of pneumococci resistant to penicillin has prompted an examination of the role of resistant organisms in the response to treatment for AOM. At this time, antibiotic-resistant organisms play a small role in the number of episodes of AOM that do not respond to initial therapy. Amoxicillin remains the drug of choice for treatment of AOM. For children who do not respond, assessment of clinical status is important. Children who are well-appearing may respond to a beta-lactamase stable oral agent. Children who are ill may require tympanostomy and presumptive therapy for infection due to resistant organisms.