Acute otitis media (AOM) and pharyngitis are very frequent diseases in pediatric parients. However, it is not always agreed which are the diagnostic criteria and empiric antibacterial treatment. It is often difficult to follow the different guidelines and not always can you choose between the different classes of antibiotics available. Furthermore, there's no unanimous agreement with respect to the most appropriate antibacterial agent to administer and the correct duration of the treatment. The aim of this article is to underline and discuss the emerging controversies in the empiric treatment of AOM and pharyngitis in pediatrics, with special attention to the use of beta-lactams in light of the most recent evidences regarding both clinical pharmacology and microbiology.