Acute otitis media and antibiotics - a systematic review

Area of Science:

• Pediatrics
• Infectious Diseases
• Evidence-Based Medicine

Background:

• Acute otitis media (AOM) is a common childhood illness.
• The benefit of antibiotics (ABX) for AOM remains debated, especially during the pneumococcal vaccine era.

Purpose of the Study:

• To systematically review randomized clinical trials (RCTs) on antibiotic efficacy for AOM.
• To evaluate the impact of ABX on pain, adverse events, and other outcomes in children with AOM.

Main Methods:

• Systematic literature search of RCTs comparing ABX to placebo for AOM from 2000-2019.
• Primary outcome: pain. Secondary outcomes: adverse events, contralateral otitis media, tympanic membrane perforation, recurrence, tympanometry, and time to resolution.

Main Results:

• Five RCTs involving 1,862 patients were analyzed.
• Number needed to treat (NNT) for pain reduction ranged from 7 to 28.
• NNT for preventing contralateral otitis media was 10; adverse events occurred in 1 in 13 patients receiving ABX.

Conclusions:

• Antibiotics show limited benefit for AOM primary and secondary outcomes compared to placebo.
• A significant proportion of children treated with ABX experience adverse events.
• Further high-quality RCTs are needed, potentially in general practice settings with high vaccine coverage.