Acute otitis media accounts for about 25-40% of all ear diseases. In newborns, it is less common (about 5%), although it is possible that this is due to diagnostic difficulties. The maximum frequency of acute purulent otitis media occurs up to the age of 6 months. (50% among all ear diseases), from 6 to 12 months. - 40%, from one year to 3 years - 30%, from 3 to 6 years - 20%, in older children, its frequency is roughly the same as in adults (10-15%). In children under 1 year of age, acute otitis media in 80% of cases takes place as a two-way process, in 1-3 years - in 60%, 4-7 years - in 25% of cases. As a result, during the first year of life, about 60% of children suffer from otitis media at least once, and 20% of children have 2-3 relapses of the disease. At 3 years, 90% of children suffer from this disease at least once, in 50% of children there are several episodes of otitis media [1].

Among bacterial pathogens, pneumococcus is the most important, followed by atypical strains of hemophilic bacillus and moraxella. In recent years, more and more reports have reported the etiological role of Chlamydophila pneumoniae and the PC virus. This opens up new opportunities for the prevention and treatment of acute otitis media (ACC). But, nevertheless, when choosing antibiotic therapy, you should always focus on pneumococcus and the hemophilic bacillus [2].

What causes and conditions lead to the fact that inflammation of the middle ear is such a common disease in childhood? They can be divided into general and local. Common features include microbial landscape, large proportion of viruses, atypical pathogens, fungal flora, childhood infections, lack of natural immunity, exudative diathesis, artificial feeding, pathology of the bronchopulmonary system and hereditary factors. There are also favorable conditions for the development of otitis media associated with the anatomical and physiological characteristics of the ENT organs of the child. These include the presence of myxoid tissue in the tympanic cavity of the newborn, a large and short auditory tube, a violation of microcirculation in the nasal cavity, adenoid vegetation, disorders of the pneumatization of the mastoid process, etc. [1].

The main symptoms of acute purulent otitis media are well known. In addition to a violation of the general condition, it is severe ear pain, hearing loss due to sound conduction and a typical otoscopic image. In childhood, and especially in early childhood, the diagnosis is difficult, because the child does not locate the source of the pain well, it is not easy to examine the hearing function and the otoscopic image present a number of features associated with age-related anatomical differences [1].

In most cases, acute suppurative otitis media ends with a cure. Recovery involves normalization of general condition, otoscopic image and complete restoration of hearing. Until the last circumstance, pediatricians, unfortunately,

The average recovery time is 3 to 4 weeks. If the suppuration lasts longer, we should talk about prolonged or subacute otitis media. In some cases, the suppuration of the ear of the child stops, the perforation of the tympanic membrane is marked, but after a while, often 2-3 times a year, the discharge from the ear reappears. In these cases, we are talking about recurrent acute otitis media. Adverse effects of acute purulent otitis media include the transition of the disease to a chronic form. The main sign of the chronization of the process is the formation of a persistent perforation of the eardrum [1].

To assess the condition of the eardrum and determine the fluid in the middle ear, a simple otoscopy and a pneumatic otoscopy are used (pneumatic otoscopy is one of the methods to determine the mobility of the eardrum). Fluid detection in the middle ear is higher with pneumatic otoscopy than with conventional otoscopy (76% and 61%, respectively). Although many clinicians do not use pneumatic otoscopy, study results indicate that determining the mobility of the tympanic membrane improves the ability to determine the presence of fluid in the middle ear, and otoscopy pneumatics should be an essential method for the diagnosis of acute otitis media [4].

In moderate to severe cases, antibiotics are almost always used, especially in children under 2 years of age. In children over 2 years of age in the absence of severe symptoms of poisoning, pain, body temperature above 38 ° C, during the day, you can only limit yourself to symptomatic treatment. However, in the absence of positive dynamics in the symptoms of diseases within 24 hours, it is necessary to start antibiotic therapy. Well-known data should be borne in mind that, in 60% of cases, CCA is authorized without antibiotics. This is typical of ACC in children over 2 years of age with a favorable profile, from wealthy families, when the disease is caused by viruses or hemophiliac bacilli [3].

Currently, three conditions are clearly formulated for the effectiveness of antibiotics in CCA: the sensitivity of the pathogen to the antibiotic; the concentration of the antibiotic in the middle ear fluid (FSW) and serum is higher than the CPI of the pathogen; maintain the concentration in the blood serum above the CPI for 40 to 50% of the time between doses of the drug, which provides an efficiency of 80 to 85%. The oral medications that meet all three conditions are amoxicillin and amoxicillin-clavulanate. Of all the available oral penicillins and cephalosporins, including generation II-III, amoxicillin is the most active against penicillin-resistant pneumococci. Amoxicillin / clavulanate, cefuroxime axetil or ceftriaxone (intramuscularly, 1 to 3 injections) may be an alternative to amoxicillin, especially for relapses of otitis media or treatment failure. According to the latest recommendations from the American Academy of Pediatrics (1998), antibiotics are recommended for use in children for 5-7 days. This is in line with the European point of view, because earlier in the United States, antibiotics were recommended for 10 to 14 days [2].

The most realistic is the introduction of a new conjugate