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These authors argue that many of the previous clinical trials suffered from significant limitations, such as the inclusion of only a small number of young children, the exclusion of children with more severe disease, and perhaps most importantly, a lack of stringent diagnostic criteria. These limitations may have biased the studies to include patients who were either misdiagnosed or more likely to recover spontaneously. To avoid these flaws, a recently published randomized controlled trial by T?htinen et al. used stringent diagnostic criteria for AOM to ensure appropriate patient selection. The criteria included specific pneumatic otoscopic findings suggestive of a middle ear effusion, such as decreased or absent http://www.selleck.cn/products/gsk-j4-hcl.html tympanic membrane mobility or air-fluid interfaces, explicit signs of acute middle ear inflammation, and fever. The authors then compared the use of amoxicillin-clavulanate or placebo in 319 young children, 6 to 35 months of age, who specifically met these diagnostic standards. The study found that antibiotic therapy reduced the risk of treatment failure by 62%. In addition, there were significantly better outcomes with antibiotic therapy in terms of both overall condition, which was based on the parent's assessment http://www.selleckchem.com/products/byl719.html of their child's general state of health (improved, no change, or worse) before and after treatment, and otoscopic signs, such as changes in the mobility and color of the tympanic membrane post-treatment, when compared with placebo (P http://www.selleckchem.com/products/BEZ235.html with amoxicillin-clavulanate resulted in significantly lower rates of clinical failure when compared with placebo; 4% versus 23% at or before day 4 or 5 of treatment (P