The Southern California/RAND Evidence-based Practice Center (EPC) performed an analysis of clinical studies conducted on children four weeks to 18 years of age from 1964 through 1998, sponsored by the Agency for Healthcare Research and Quality (AHRQ). In this analysis the investigators found, a large percentage of children, nearly two-thirds of those studied,  “with uncomplicated acute otitis media...recover from pain and fever within 24 hours of diagnosis without (antibiotic) treatment...and over 80% recover within 1 to 7 days.”

The Evidence-based Practice Center estimates that over 5 million episodes of acute otitis media occur each year in the US at a cost of approximately $3 billion. In the United States it is routine to use antibiotics as a first treatment approach.  This is in contrast to other countries, such as the Netherlands, where the standard practice is to use "watchful waiting" for one to two days after the onset of an ear infection in children over two years of age. In these countries antibiotic use is only called for if the infection fails to improve during that time.  Because of the difference in antibiotic usage between the US and the Netherlands,  the rate of bacterial resistance in the Netherlands is about 1 percent, compared with the US average of around 25 percent.  This indicates that the US uses antibiotics more than other countries.  Additionally, not only is antibiotic use possibly unwarranted, but questionable in their effectiveness.