Systemic corticosteroids for acute otitis media in children

Area of Science:

• Pediatric infectious diseases
• Pharmacology and therapeutics

Background:

• Acute otitis media (AOM) is a frequent childhood infection, with pain being its most significant symptom.
• Antibiotics offer modest pain relief in AOM, and evidence for other treatments like systemic corticosteroids is limited.
• Systemic corticosteroids, potent anti-inflammatory agents, may offer therapeutic benefits for AOM, alone or with antibiotics.

Purpose of the Study:

• To evaluate the efficacy of systemic corticosteroids (oral or parenteral), with or without antibiotics, in treating AOM in pediatric patients.
• To synthesize evidence from randomized controlled trials (RCTs) comparing corticosteroids to placebo for AOM management.

Main Methods:

• Comprehensive literature search of multiple databases (CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, LILACS) and clinical trial registries.
• Inclusion of RCTs in children with AOM comparing systemic corticosteroids (with or without antibiotics) against placebo.
• Independent data extraction, risk of bias assessment using Cochrane Handbook criteria, and GRADE methodology for quality assessment.

Main Results:

• Two RCTs (252 children) were included; both had unclear to high risk of bias.
• Low-quality evidence suggests uncertain effects on symptom reduction (Day 5: RR 1.06, 95% CI 0.97-1.16; Day 14: RR 1.05, 95% CI 0.95-1.17).
• One study indicated potential benefit for favorable outcomes (aOR 65.9, P=0.037), but data on adverse effects were insufficient.

Conclusions:

• The current evidence regarding systemic corticosteroids for AOM is of low to very low quality.
• The precise impact of systemic corticosteroids on key clinical outcomes in AOM remains uncertain.
• Large, high-quality studies are essential to definitively ascertain the role of systemic corticosteroids in AOM treatment.