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The guidelines do not endorse any one method, but note that the safety of oral and topical analgesics such as acetaminophen and otic preparations likely outweighs any minor risks for their use. This strategy has come from two key observationsthe first is that antibiotic resistance 28 R. Because otitis media can put children at risk for speech, language, and learning problems, high-risk children should not simply be observed. The at-risk children include those with preexisting hearing deficits, with speech or language delay, with certain pervasive develop- mental disorders, and with other developmental delays. Data suggesting that tympanostomy tubes do not prevent or change speech or language delay further supports a watchful waiting strategy in low risk children.

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Chemo- therapy can result in cyst regression or col- lapse, although prolonged courses of therapy 46, 50, 51 It has been esti- are usually required. Echinococcus multilocularis alveolar mebendazole because the former is metabo- cyst from an infected vole. It infected sheep and dogs led to the total eradi- is also prevalent in the Russian Federation cation of the disease. Attempts to duplicate and Central Asia, China especially in west- 59 that effort in Cyprus were not as successful. The oncosphere hatches high levels of protection in sheep, and may in the small intestine and invades the liver 60 by the hematogenous route.

The intermediate hosts are In humans, the incubation period of larval usually rodents e. The initial tion in humans resembles the situation found exposure often occurs during childhood, but in the intermediate hosts. The mem- tilocularis does not produce protoscolices in brane proliferates indefnitely and causes pro- human infection, only membranes that grow gressive destruction of the liver parenchyma, and bisect whatever organ they happen to be which can lead to hepatic failure. In some in, confounding the diagnosis of this unusual cases this may lead to direct extension to 67 parasitic disease.

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