OBJECTIVES: Acute otitis media (AOM) is an important problem mainly in children age. It often results in serious illnesses such as pneumonia, meningitis and accumulated fluid can cause significant hearing impairment, and may interfere with the development of normal speech in infancy. Antimicrobials are treatment of choice. Our objective was to analyze antibiotic prescribing and evaluate cost of antimicrobial treatment acute otitis media.METHODS: Same protocols and methodology was applied for multicentric study; 4 weeks prospective study in November 2003; 66 paediatricians in 5 Slovak cities. Validation of antibiotic prescribing according guidelines. CMA (cost-minimisation analysis) were used. Utilisation of antibiotics in WHO ATC/DDD system. RESULTS: Out of 326 patients, to 179 (54.9%) were indicated antibiotic treatment. The most frequent prescribing antibiotic were co-aminopenicillins (J01CR) in 54 patients (31.2%, 229.5 DDD), second were penicillins (J01CE) in 37 cases (21.4%, 143 DDD), then cephalosporins (J01D) in 35 cases (20.2%, 129 DDD), aminopenicillins (J01CA) in 24 cases (13.9%, 135.4 DDD), macrolides (J01FA) in 18 cases (10.4%, 109 DDD). The largest rate of total cost for antimicrobial therapy of AOM were spend for alternative choices: co-aminopenicillins (36.5), cephalosporines (24.3%) and macrolides (24.1%). Cost for amoxicillin as first choice drug was 4.3%, for alternative antimicrobials 84.9% and other antimicrobials (10.8%). CONCLUSION: Acute otitis media is serious infection illness which needs to be cured by antimicrobials. More often were indicated alternative antibiotics, with more expensive average cost for therapy. Reasonable use of antibiotic is necessary to maintain the resistance at low level and aim to decrease total cost.