- The role of antibiotics in acute otitis media is to eradicate the causative pathogen from the middle ear. It is therefore important to have antibiotics with good activity which reach the organism in an appropriate concentration at the infection site. Without these parameters successful treatment will not be achieved. The ultimate test of this concept is to demonstrate the eradication of a pathogen from middle ear aspirate post-treatment. Careful analysis of treatment failures show that increasing rate of resistance to existing drugs is associated with a decreased rate of pathogen eradication in acute otitis media and there is a clear correlation between bacteriologic failure and clinical failure.