Sir:—The article by McLinn entitled "Cefaclor in Treatment of Otitis Media and Pharyngitis in Children" (Journal 1980;134:560-563) contains several serious deficiencies in design, as well as misleading statements that I believe should be brought to the attention of your readers.
His patients received for from ten days to three weeks treatment "depending on clinical and bacteriologic response," yet it is not stated whether treatment duration differed between the amoxicillin trihydrate and cefaclor groups. The definitions of relapse and reinfection in the otitis group seem unjustified; since the pneumococcus and Haemophilus accounted for nearly 80% of all bacterial isolates from the middle ear, and since both are normal flora of the nasopharynx, it is quite likely that a second episode of infection with the same organisms might occur without being a relapse. Evaluation of changes in the middle ear and tympanic membrane is highly subjective. The tympanogram has provided a