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Increased clinical failures when treating acute otitis media with macrolides: a meta-analysis

Joshua D Courter1, William L Baker, Katherine S Nowak

  • 1Connecticut Children's Medical Center, Hartford, CT 06106, USA.

The Annals of Pharmacotherapy
|February 13, 2010
PubMed
Abstract

Insights

Macrolide antibiotics show increased clinical failure rates for acute otitis media (AOM) in children compared to amoxicillin. Current guidelines recommending amoxicillin or amoxicillin/clavulanate for AOM are supported by this evidence.

Area of Science:

  • Pediatric Infectious Diseases
  • Pharmacology
  • Evidence-Based Medicine

Background:

  • Macrolide antibiotics are frequently prescribed for acute otitis media (AOM) in children.
  • Current guidelines suggest avoiding macrolides in favor of penicillin-based treatments unless a penicillin allergy exists.

Purpose of the Study:

  • To conduct a meta-analysis comparing the efficacy of amoxicillin or amoxicillin/clavulanate against macrolide antibiotics for treating pediatric AOM.
  • To evaluate clinical failure rates and safety profiles of these antibiotic classes.

Main Methods:

  • Systematic literature search of major databases (MEDLINE, EMBASE, International Pharmaceutical Abstracts) through September 2008.
  • Inclusion of randomized, blinded, controlled trials comparing guideline-recommended antibiotics with macrolides in pediatric AOM.
  • Primary outcome: clinical failure assessed 10-16 days post-therapy; secondary outcome: adverse reactions and diarrhea.

Main Results:

  • Meta-analysis of 10 trials (N=2766) revealed a significantly increased risk of clinical failure with macrolide use (RR 1.31; p=0.008).
  • Macrolide group showed significantly lower rates of adverse reactions (RR 0.74; p=0.003) and diarrhea (RR 0.41; p<0.0001).

Conclusions:

  • Macrolide antibiotics are associated with a higher likelihood of clinical failure in pediatric AOM treatment.
  • Findings support existing recommendations to reserve macrolides for children unable to take amoxicillin or amoxicillin/clavulanate.

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