Antibiotics for acute otitis media in children (Review)

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Abstract

Background
Acute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56% in the Netherlands to 95% in the USA and Australia.

Objectives
To assess the effects of antibiotics for children with AOM.

Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, issue 2) which contains the Acute Respiratory Infections (ARI) Group's Specialized Register; MEDLINE (1966 to June week 4 2008); OLDMEDLINE (1958 to 1965); EMBASE (January 1990 to July 2008); and Current Contents (1966 to July 2008).

Selection criteria
Randomised controlled trials comparing 1) antimicrobial drugs with placebo 2) immediate antibiotic treatment with observational treatment approaches in children with AOM.

Data collection and analysis
Three review authors independently assessed trial quality and extracted data.

Main results
We found 10 trials (2928 children) from high income countries with low risk of bias. Pain was not reduced by antibiotics at 24 hours, but was at two to seven days, (relative risk (RR) 0.72; 95% confidence interval 0.62 to 0.83). However four trials (1271 children) comparing antibiotics prescribed immediately rather than initial observation found no difference at three to seven days. Antibiotics did not reduce tympanometry, perforation or recurrence. The only case of mastoiditis was in an antibiotic treated child. Vomiting, diarrhoea or rash was higher in children taking antibiotics (RR 1.37; 95% CI 1.09 to 1.76). Individual patient data meta‐analysis of a subset of the included trials found antibiotics to be most beneficial in children: aged less than two; with bilateral AOM and with both AOM and otorrhoea.

Authors' conclusions
Antibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain. This benefit must be weighed against the possible harms: 1 in 24 children experience symptoms caused by antibiotics. Antibiotics are most useful in children under two years of age, with bilateral AOM, and with both AOM and discharging ears. For most other children with mild disease, an expectant observational approach seems justified. We have no data on populations with higher risks of complications.
Original languageEnglish
Article numberCD000219
Pages (from-to)1-43
Number of pages43
JournalCochrane Database of Systematic Reviews
Volume2004
Issue number1
DOIs
Publication statusPublished - 2004
Externally publishedYes

Fingerprint

Otitis Media
Anti-Bacterial Agents
Pain
Ear
Mastoiditis
Acoustic Impedance Tests
Middle Ear
Exanthema
MEDLINE
Respiratory Tract Infections
Netherlands
Libraries
Vomiting
Diarrhea
Placebos
Observation
Confidence Intervals

Cite this

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title = "Antibiotics for acute otitis media in children (Review)",
abstract = "BackgroundAcute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56{\%} in the Netherlands to 95{\%} in the USA and Australia.ObjectivesTo assess the effects of antibiotics for children with AOM.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, issue 2) which contains the Acute Respiratory Infections (ARI) Group's Specialized Register; MEDLINE (1966 to June week 4 2008); OLDMEDLINE (1958 to 1965); EMBASE (January 1990 to July 2008); and Current Contents (1966 to July 2008).Selection criteriaRandomised controlled trials comparing 1) antimicrobial drugs with placebo 2) immediate antibiotic treatment with observational treatment approaches in children with AOM.Data collection and analysisThree review authors independently assessed trial quality and extracted data.Main resultsWe found 10 trials (2928 children) from high income countries with low risk of bias. Pain was not reduced by antibiotics at 24 hours, but was at two to seven days, (relative risk (RR) 0.72; 95{\%} confidence interval 0.62 to 0.83). However four trials (1271 children) comparing antibiotics prescribed immediately rather than initial observation found no difference at three to seven days. Antibiotics did not reduce tympanometry, perforation or recurrence. The only case of mastoiditis was in an antibiotic treated child. Vomiting, diarrhoea or rash was higher in children taking antibiotics (RR 1.37; 95{\%} CI 1.09 to 1.76). Individual patient data meta‐analysis of a subset of the included trials found antibiotics to be most beneficial in children: aged less than two; with bilateral AOM and with both AOM and otorrhoea.Authors' conclusionsAntibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78{\%}) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain. This benefit must be weighed against the possible harms: 1 in 24 children experience symptoms caused by antibiotics. Antibiotics are most useful in children under two years of age, with bilateral AOM, and with both AOM and discharging ears. For most other children with mild disease, an expectant observational approach seems justified. We have no data on populations with higher risks of complications.",
author = "Sharon Sanders and Glasziou, {Paul P} and {Del Mar}, {Chris B} and Rovers, {Maroeska M.}",
note = "Reprinted with permission From: Duncan James [DJames@wiley.co.uk] on behalf of Permission RequestsUK [permreq@wiley.co.uk] Sent: Monday, 26 June 2006 6:53 PM To: Yvonne Auld Subject: Re: Permission to archive 6 article from The Cochrane Library in the Bond University Institutional Repository Dear Ms Auld Thank you for your request. We are pleased to advise that under the terms of the Licence to Publish form signed by authors when submitting articles to the Cochrane Library, authors are permitted to place an electronic file of their Review on their own personal website and/or their institution's website. This would seem to cover your requested use of the material. (For information, please note that this is a particular feature of the author agreement for the Cochrane Library, and not all Wiley publications permit self-archiving in institutional repositories.) The following notice must accompany the electronic files: 'This review is published as a Cochrane Review in The Cochrane Library 20XX, Issue X. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and The Cochrane Library should be consulted for the most recent version of the Review.' (This statement should refer to the latest version of The Cochrane Library in which the Review appears.) Yours sincerely Duncan James",
year = "2004",
doi = "10.1002/14651858.CD000219.pub2",
language = "English",
volume = "2004",
pages = "1--43",
journal = "Cochrane database of systematic reviews (Online)",
issn = "1469-493X",
publisher = "Wiley-Blackwell",
number = "1",

}

Antibiotics for acute otitis media in children (Review). / Sanders, Sharon; Glasziou, Paul P; Del Mar, Chris B; Rovers, Maroeska M.

In: Cochrane Database of Systematic Reviews, Vol. 2004, No. 1, CD000219, 2004, p. 1-43.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Antibiotics for acute otitis media in children (Review)

AU - Sanders, Sharon

AU - Glasziou, Paul P

AU - Del Mar, Chris B

AU - Rovers, Maroeska M.

N1 - Reprinted with permission From: Duncan James [DJames@wiley.co.uk] on behalf of Permission RequestsUK [permreq@wiley.co.uk] Sent: Monday, 26 June 2006 6:53 PM To: Yvonne Auld Subject: Re: Permission to archive 6 article from The Cochrane Library in the Bond University Institutional Repository Dear Ms Auld Thank you for your request. We are pleased to advise that under the terms of the Licence to Publish form signed by authors when submitting articles to the Cochrane Library, authors are permitted to place an electronic file of their Review on their own personal website and/or their institution's website. This would seem to cover your requested use of the material. (For information, please note that this is a particular feature of the author agreement for the Cochrane Library, and not all Wiley publications permit self-archiving in institutional repositories.) The following notice must accompany the electronic files: 'This review is published as a Cochrane Review in The Cochrane Library 20XX, Issue X. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and The Cochrane Library should be consulted for the most recent version of the Review.' (This statement should refer to the latest version of The Cochrane Library in which the Review appears.) Yours sincerely Duncan James

PY - 2004

Y1 - 2004

N2 - BackgroundAcute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56% in the Netherlands to 95% in the USA and Australia.ObjectivesTo assess the effects of antibiotics for children with AOM.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, issue 2) which contains the Acute Respiratory Infections (ARI) Group's Specialized Register; MEDLINE (1966 to June week 4 2008); OLDMEDLINE (1958 to 1965); EMBASE (January 1990 to July 2008); and Current Contents (1966 to July 2008).Selection criteriaRandomised controlled trials comparing 1) antimicrobial drugs with placebo 2) immediate antibiotic treatment with observational treatment approaches in children with AOM.Data collection and analysisThree review authors independently assessed trial quality and extracted data.Main resultsWe found 10 trials (2928 children) from high income countries with low risk of bias. Pain was not reduced by antibiotics at 24 hours, but was at two to seven days, (relative risk (RR) 0.72; 95% confidence interval 0.62 to 0.83). However four trials (1271 children) comparing antibiotics prescribed immediately rather than initial observation found no difference at three to seven days. Antibiotics did not reduce tympanometry, perforation or recurrence. The only case of mastoiditis was in an antibiotic treated child. Vomiting, diarrhoea or rash was higher in children taking antibiotics (RR 1.37; 95% CI 1.09 to 1.76). Individual patient data meta‐analysis of a subset of the included trials found antibiotics to be most beneficial in children: aged less than two; with bilateral AOM and with both AOM and otorrhoea.Authors' conclusionsAntibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain. This benefit must be weighed against the possible harms: 1 in 24 children experience symptoms caused by antibiotics. Antibiotics are most useful in children under two years of age, with bilateral AOM, and with both AOM and discharging ears. For most other children with mild disease, an expectant observational approach seems justified. We have no data on populations with higher risks of complications.

AB - BackgroundAcute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56% in the Netherlands to 95% in the USA and Australia.ObjectivesTo assess the effects of antibiotics for children with AOM.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, issue 2) which contains the Acute Respiratory Infections (ARI) Group's Specialized Register; MEDLINE (1966 to June week 4 2008); OLDMEDLINE (1958 to 1965); EMBASE (January 1990 to July 2008); and Current Contents (1966 to July 2008).Selection criteriaRandomised controlled trials comparing 1) antimicrobial drugs with placebo 2) immediate antibiotic treatment with observational treatment approaches in children with AOM.Data collection and analysisThree review authors independently assessed trial quality and extracted data.Main resultsWe found 10 trials (2928 children) from high income countries with low risk of bias. Pain was not reduced by antibiotics at 24 hours, but was at two to seven days, (relative risk (RR) 0.72; 95% confidence interval 0.62 to 0.83). However four trials (1271 children) comparing antibiotics prescribed immediately rather than initial observation found no difference at three to seven days. Antibiotics did not reduce tympanometry, perforation or recurrence. The only case of mastoiditis was in an antibiotic treated child. Vomiting, diarrhoea or rash was higher in children taking antibiotics (RR 1.37; 95% CI 1.09 to 1.76). Individual patient data meta‐analysis of a subset of the included trials found antibiotics to be most beneficial in children: aged less than two; with bilateral AOM and with both AOM and otorrhoea.Authors' conclusionsAntibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain. This benefit must be weighed against the possible harms: 1 in 24 children experience symptoms caused by antibiotics. Antibiotics are most useful in children under two years of age, with bilateral AOM, and with both AOM and discharging ears. For most other children with mild disease, an expectant observational approach seems justified. We have no data on populations with higher risks of complications.

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