Study to Identify and Characterize Bacteria Causing Acute Otitis Media in South African Children

Inclusion Criteria: Inclusion criteria for all subjects: * Age: \>= 3 months and \< 5 years at the time of enrolment. * Signs, symptoms, and conditions: * One of the functional or general signs of otalgia,, conjunctivitis, fever and either * Paradise's criteria or * Spontaneous otorrhoea of less than 24 hours. * Subject will be included as a treatment failure case. * Written informed consent obtained from parent or guardian prior to study start. Inclusion criteria for HIV-positive subjects: * Documented HIV-positive status as given in subject's medical records. or * Subjects referred from paediatric HIV clinic. Inclusion criteria for HIV-negative subjects (including presumed negative children) * Children who have been tested HIV-negative. * Children whose mothers volunteer to have tested HIV-negative whilst pregnant with the index case and the child is free to any World Health Organization Grade II stigmata of HIV/acquired immunodeficiency syndrome. * Children who do not fulfil the World Health Organization staging for HIV infection / immunosuppression. Exclusion Criteria: * Hospitalised during the diagnosis of acute otitis media or during treatment. * Otitis externa or otitis media with effusion. * Presence of a transtympanic aerator. * Systemic antibiotic treatment received for a disease other than acute otitis media in the 72 hours prior to enrolment. * Receiving antimicrobial prophylaxis for recurrent acute otitis media but excluding cotrimoxazole or isoniazid prophylaxis in HIV exposed children. * Provision of antibiotic by paediatrician/ENT specialist at the enrolment visit prior to the sampling of the middle ear fluid or spontaneous Otorrhoea. * Children on antibiotics for acute otitis media who are clinically improving.