Children with fever and vomiting benefit from immediate antibiotics for acute otitis media.

Starting antibiotics immediately in children with acute otitis media accompanied by fever or vomiting results in better symptom relief and decreased sleep disturbance when measured after 3 days, as compared with no treatment. Parents who consider these outcomes important may prefer not to delay antibiotic treatment. Conversely, children without fever or vomiting tend to have the same duration of symptoms regardless of antibiotic treatment and are suitable for a "wait and see" approach.