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Short course antibiotics for acute otitis media
A L Kozyrskyj1, G E Hildes-Ripstein, S E Longstaffe
1Community Health Sciences, Faculty of Medicine, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba, Canada, R3E 0W3. moffatt@bldghsc.1an1.umanitoba.ca
Insights
A five-day course of short-acting antibiotics effectively treats uncomplicated pediatric ear infections, showing similar outcomes to longer antibiotic durations. This approach reduces unnecessary antibiotic exposure in children with acute otitis media.
Area of Science:
- Pediatric infectious diseases
- Pharmacology and therapeutics
Background:
- Otitis media is a prevalent childhood illness frequently treated with antibiotics.
- Antibiotic prescribing practices for otitis media vary, with differing durations of treatment.
Purpose of the Study:
- To compare the efficacy of short antibiotic courses (less than seven days) versus longer courses (seven days or more) for treating acute otitis media in children.
- To evaluate treatment outcomes and identify optimal antibiotic durations for pediatric ear infections.
Main Methods:
- A systematic review of randomized controlled trials (RCTs) was conducted, focusing on studies published between 1966 and 1997.
- Included studies involved children aged one month to 18 years diagnosed with ear infections, who had not received prior antimicrobial therapy.
- Data were analyzed using summary odds ratios (OR) to compare treatment failure rates between short-term and long-term antibiotic regimens.
Main Results:
- Initial outcomes at 8-19 days showed a higher failure rate with a five-day course compared to 8-10 days (OR=1.52).
- However, by 20-30 days, treatment outcomes were comparable between short (five days) and longer antibiotic courses (OR=1.22).
- Absolute differences in treatment failure at 20-30 days suggest minimal benefit from longer courses, with similar outcomes observed up to three months.
Conclusions:
- A five-day course of short-acting antibiotics is an effective treatment for uncomplicated pediatric ear infections.
- The findings support the use of shorter antibiotic durations, potentially reducing antibiotic resistance and side effects in children.
- Comparable outcomes were observed with specific antibiotics like ceftriaxone and azithromycin, regardless of treatment duration exceeding seven days.
Background:
Otitis media is a common pediatric problem, for which antibiotics are frequently prescribed.
Objectives:
To determine the effectiveness of a short course of antibiotics (less than seven days) in comparison to a longer course (seven days or greater) for the treatment of acute otitis media in children.
Search Strategy:
The medical literature was searched for randomized controlled studies of the treatment of ear infections in children with antibiotics published from January 1966 to July 1997. Search last updated March 1998.
Selection Criteria:
Studies were included if they met the following criteria: subjects one month to 18 years of age, clinical diagnosis of ear infection, no previous antimicrobial therapy and randomization to treatment with less than seven days versus seven days or more of antibiotics.
Data Collection And Analysis:
Data on treatment outcomes were extracted from individual studies, and combined in the form of a summary odds ratio. A summary odds ratio (OR) equivalent to one indicated that the treatment failure rate following less than seven days of antibiotic treatment was similar to the failure rate following seven days or more of antibiotic.
Main Results:
The summary OR for treatment outcomes at eight to 19 days in 1,524 children treated with short-acting antibiotics for five days versus eight to 10 days was 1.52, 95% CI: 1.17-1.98, but by 20 to 30 days outcomes between treatment groups (n=2,115) were comparable (OR=1.22, 95% CI:0.98-1.54). The absolute difference in treatment failure (Random effects model RD=2.9%, 95%CI:-0.3% to 6.1%) at 20 to 30 days suggests that at minimum 17 children would need to be treated with the long course of short-acting antibiotics to avoid one treatment failure. Similarity in outcomes was observed for up to three months following therapy (OR=1.16,95% CI=0.9-1.5). Comparable outcomes were shown between treatment with ceftriaxone or azithromycin, and more than seven days of other antibiotics.
Reviewer'S Conclusions:
This review suggests that five days of short-acting antibiotic is effective treatment for uncomplicated ear infections in children.