Antibiotics for otitis media
Date First Published:
September 5, 2000
Last Updated:
September 15, 2004
Report by:
Angaj Ghosh, Senior Clinical Fellow (Manchester Royal Infirmary)
Search checked by:
Rupert Jackson, Manchester Royal Infirmary
Three-Part Question:
In [a systemically well child with otitis media] are [oral antibiotics better than placebo] at [decreasing time to recovery and reducing the incidence of secondary complications]?
Clinical Scenario:
A 2 year old child is brought into the emergency department with a general malaise and irritability for the last 24 hours. Examination of the right ear reveals a diffusely red bulging ear drum. A diagnosis of acute otitis media is made. You wonder whether there is any evidence that oral antibiotics would decrease the time to recovery and prevent secondary complications.
Search Strategy:
Medline 1966-11/00 using the OVID interface.
Search Details:
[(exp otitis media OR otitis media.mp OR acute otitis media.mp OR acute red ear.mp) AND (exp antibiotics OR antibiotic$.mp OR exp amoxycillin OR amoxycillin.mp OR exp amoxicillin-potassium clavulanate combination OR augmentin.mp OR co-amoxyclav.mp OR exp erythromycin OR exp erythromycin estolate OR erythromycin.mp OR exp penicillins OR penicillin.mp OR non-antibiotic treatment.mp OR placebo.mp)] AND maximally sensitive RCT filter LIMIT to human AND english.
Outcome:
865 papers were found of which 10 were relevant and had been meta-analysed by the Cochrane review group which was last updated on 28/04/2000. No further relevant papers have been published since. A meta-analysis done in 1994 was also selected.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials Rosenfeld RM, Vertrees JE, Carr J et al. 1994 USA | 33 trials including 5400 children with acute otitis media Antibiotics vs no antibiotics |
Meta-analysis | Complete clinical resolution of signs (primary control) | Compared with placebo or no drug, antimicrobial therapy increased primary control by 13.7% (8.2% to 19.2%) (NNT=7) | Outcome not patient orientated |
| Antibiotics for acute otitis media in children (Cochrane Review) In: The Cochrane Library, Issue 3, 2000. Oxford: Update Software. Glasziou PP, Del Mar CB, Hayem M. 2000 UK | 7 trials with patient related outcomes. Total inclusion of 2,202 children with acute otitis media. Antibiotics vs no antibiotics |
Systematic review | Hearing between 1 and 3 months | No significant difference | Only one episode of mastoiditis in all the trials |
| Pain between 2 and 7 days | 28% (CI 15%-38%) relative reduction with antibiotics (NNT=17) | ||||
| Pain at 24 hours | No difference |
Author Commentary:
Most cases of otitis media will spontaneously resolve.
Bottom Line:
There is benefit from the use of antibiotics in otitis media.
References:
- Rosenfeld RM, Vertrees JE, Carr J et al.. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials
- Glasziou PP, Del Mar CB, Hayem M.. Antibiotics for acute otitis media in children (Cochrane Review) In: The Cochrane Library, Issue 3, 2000. Oxford: Update Software.