Growing concern about the rapid emergence of penicillin-resistantStreptococcus pneumoniae, as well as β-lactamase-mediated resistance amongHaemophilus influenzaeandMoraxella catarrhalis, has lead to reconsideration of the management of acute otitis media in children. Acute otitis media is the most common disorder diagnosed by paediatricians and among the most common indications for which antibacterial agents are prescribed in children.Although there is little consensus regarding the optimal management of children with acute otitis media, the need for judicious use of antibacterial agents is generally recognised. Several initiatives have been undertaken in an attempt to improve the management practices for this infection. One recent example is the recommendations of the US Drug-ResistantS. pneumoniae(DRSP) Therapeutic Working Group which advocate an accurate diagnosis of acute otitis media, a step-wise approach to treatment and a role for diagnostic tympanocentesis in children who do not respond to therapy. Based on pharmacokinetic and efficacy data, amoxicillin is recommended as first-line treatment. Cefuroxime axetil, amoxicillin/clavulanic acid and ceftriaxone are recommended as second-line options.ConclusionsCefuroxime axetil is one of very few oral agents which has proven clinical efficacy againstS. pneumoniae, as well as β-lactamase-producingH. influenzaeandM. catarrhalis. Although not as palatable as some other oral paediatric formulations, it has significantly better gastrointestinal tolerability than amoxicillin/clavulanic acid, another oral agent with a similar activity profile, and can be administered conveniently in 2 divided daily doses. Cefuroxime axetil is, therefore, an important oral treatment option for children with acute otitis media.