Active chronic suppurative otitis media poses a management problem. Different types of treatment strategy were tried for 136 patients, 36 patients received systemic antibiotics, 26 patients received local antibiotics, 42 patients combined local and systemic, and the last group (32 patients) received no antibiotics. The majority of patients had moderate size tympanic membrane perforation (59%). Eighty-two patients had severe (active) symptoms (60%). The commonest types of bacteria isolated were streptococcus pneumoniae and staphylococcus aureus (29%, 21% respectively). It is found that, the best type of treatment was the local antibiotic therapy (84% improvement), followed by combined antibiotic therapy (local and systemic) which equal to 83% improvement. There was no benefit of using systemic antibiotics without aural toilet (5% improvement). It is important to mention that the use of antibiotic/ steroid ear drop gave good improvement result (95%), in comparison with the use of antibiotic ear drop (50%).