There is a wide range of reported clinical failure rates in the first week in children with AOM who are not treated with antibiotics. The pooled estimates indicate that a majority of these children have clinical resolution within the first week after presentation. These studies, which generally are of small sample size, report few episodes of suppurative complications, regardless of antibiotic treatment. In general, the children in the natural history studies had close followup. Antibiotic treatment with ampicillin or amoxicillin produces a statistically significant improvement in failure rates compared with no antibiotic treatment of AOM. No difference was found in clinical failure rates in the antibiotic regimens assessed. Several studies suggest that greater caution be taken with children younger than 2 years old.