This article can explain the treatment of acute otitis media, but for individualized treatment it must also be combined with clinical experience and should not be prescriptive. Acute otitis media (AOM) is an acute purulent inflammation of the middle ear mucosa that occurs in children, and the American Academy of Pediatrics (APP) has published clinical practice guidelines for AOM in children. Acute otitis media (AOM) is an acute purulent inflammation of the middle ear mucosa that occurs in children, most often in the winter and spring when influenza is prevalent. Inadequate treatment can lead to tympanic membrane perforation and hearing loss in some children. For this reason, the American Academy of Pediatrics (APP) has released the clinical practice guideline for pediatric AOM, which focuses on the treatment and prevention of otitis media simplex in children aged 6 months-12 years for clinicians. 1. Diagnosis of AOM In fact, the symptoms of AOM appear continuously as the disease progresses, and there is no gold standard for AOM diagnosis. AOM in older children mostly has a history of acute episodes of ear pain, and in infants and young children, ear pain mostly occurs after pulling on the ear and is accompanied by fever, crying, and changes in sleep-eating behavior. Clinicians should consider the diagnosis of AOM in children with moderate or severe tympanic membrane swelling or new-onset ear leakage due to non-extralinguinal otitis, mild tympanic membrane swelling with recent otalgia (within 48 hours), or severe erythema of the tympanic membrane. AOM should not be diagnosed in children with no middle ear leakage on otoscopy. 2. Treatment of Earache Most episodes of AOM are accompanied by earache, and if present, pain should be evaluated and treated aggressively. pain associated with AOM occurs early in the course of the disease, and pain lasts longer in young children. Antibiotic treatment does not provide relief within 24 hours, especially in children less than 2 years of age, and pain may last 3-7 days. Analgesic medications can provide relief of AOM-related pain within 24 hours, and aggressive treatment of pain within the first 24 hours of onset, with or without antibiotics, is recommended. Acetaminophen and ibuprofen are the main analgesic drugs for the treatment of AOM pain and can be effective for mild to moderate pain relief. 3. Antibiotic therapy The rationale for antibiotic therapy is that bacterial cultures of middle ear leakage are mostly positive. It is recommended that children with AOM ≥ 6 months of age with severe symptoms (such as moderate to severe ear pain, or ear pain lasting at least 48 hours, or temperature ≥ 39°C) should be given antibiotic therapy; children with bilateral AOM younger than 24 months of age should be given antibiotic therapy even if they do not have severe symptoms. For children with AOM without severe symptoms and aged ≥ 24 months; or children with unilateral AOM without severe symptoms and aged 6-23 months, antibiotics can be used or closely observed for follow-up, and antibiotic therapy should be started if symptoms do not improve or continue to worsen within 48-72 hours. 4. antibiotic selection Once the decision to administer antibiotics has been made, clinicians must choose appropriate agents that are effective against pathogenic bacteria based on potential advantages and disadvantages. aOM often occurs after viral upper respiratory tract infections, where inflammation and dysfunction of the eustachian tube can cause bacteria and viruses from the nasopharynx to enter the middle ear. bacteria and respiratory viruses can be detected in middle ear leakage in 96% of patients with AOM. High-dose amoxicillin, as the first-line drug for AOM treatment, should be considered first for children with AOM who do not have penicillin allergy, have not used amoxicillin in the past 30 days, do not have concurrent septic conjunctivitis, and require antibiotic therapy. The recommended dose of amoxicillin is 80-90 mg/kg daily in two divided doses; or amoxicillin-clavulanic acid, 90 mg/kg daily for amoxicillin and 6,4 mg/kg daily for clavulanic acid in two divided doses. Other beta-lactams may be considered in children with AOM who have recurrent AOM that has failed amoxicillin therapy, or is complicated by septic conjunctivitis, or who have used amoxicillin within the past 30 days and require antibiotic therapy. Children with no improvement or worsening of symptoms 48-72 hours after initiation of antibiotic therapy should be reassessed and a change in treatment regimen should be considered. Alternative therapeutic agents include cefdinir, cefuroxime, cefpodoxime, and ceftriaxone. For children less than 2 years of age with severe symptoms, a 10-day course of standard medication is recommended; for children 2 to 5 years of age with mild to moderate AOM, 7 days of oral antibiotics are recommended; for children 6 years of age and older with mild to moderate AOM, the duration of treatment is usually 5-7 days. 5. Recurrent AOM Recurrent AOM is defined as 3 or more episodes of AOM within 6 months, or at least 4 episodes within 12 months and at least one occurring in the previous 6 months. Winter, boys, and exposure to secondhand smoke are associated with an increased risk of recurrent AOM; half of children younger than 2 years who have had AOM will have a recurrence within 6 months; and symptoms lasting more than 10 days also indicate the possibility of recurrence. For children with recurrent AOM, prophylactic antibiotics are not recommended to reduce the recurrence of AOM, but tympanostomy tube insertion can be considered. 6. Prevention of AOM The pneumococcal conjugate vaccine has been shown to be effective in preventing otitis media caused by pneumococci, and pneumococcal conjugate vaccination is recommended for all children according to the immunization schedule. Many cases of AOM occur after upper respiratory infections caused by influenza viruses, and about 2/3 of younger children with influenza may have AOM as a complication. studies have confirmed that the influenza vaccine can prevent 30-55% of AOM occurrences during the respiratory disease epidemic season. Also, breastfeeding for at least 4-6 months can reduce the occurrence of AOM and the recurrence of AOM. In addition, reducing exposure to secondhand smoke has been shown to reduce the incidence of AOM in infants and children, while bottle and rubber nipple use increases the incidence of AOM, and good lifestyle habits can reduce the incidence of AOM. Prevention of upper respiratory tract infections during infancy and early childhood can also significantly reduce the incidence of AOM.