Related Experiment Videos
Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis
C Del Mar1, P Glasziou, M Hayem
1Centre for General Practice, University of Queensland, Graduate School of Medicine, Brisbane, Australia.
Insights
Antibiotic treatment for acute otitis media in children offers modest benefits, reducing pain risk and preventing some cases of ear infections. However, antibiotics significantly increase the risk of side effects like vomiting and diarrhea.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Antibiotic use for AOM is widespread but debated.
- Evidence on the net benefit of antibiotics for AOM is crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of antibiotic treatment for AOM in children.
- To quantify the benefits and risks associated with early antibiotic intervention.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) on AOM treatment.
- Inclusion of six high-quality studies involving children aged 7 months to 15 years.
- Assessment of outcomes including pain, deafness, and treatment-related adverse events.
Main Results:
- Antibiotics did not expedite pain relief within the first 24 hours.
- Early antibiotic use reduced pain risk between 2-7 days by 41% and contralateral AOM by 43%.
- Adverse events such as vomiting, diarrhea, and rashes doubled with antibiotic use.
Conclusions:
- The early administration of antibiotics for AOM yields only a modest clinical benefit.
- Treating 17 children with antibiotics early is required to prevent one child from experiencing pain at 2-7 days.
- The increased risk of adverse effects should be considered in the clinical decision-making process.
Objective:
To determine the effect of antibiotic treatment for acute otitis media in children.
Design:
Systematic search of the medical literature to identify studies that used antibiotics in randomised controlled trials to treat acute otitis media. Studies were examined blind, and the results of those of satisfactory quality of methodology were pooled.
Subjects:
Six studies of children aged 7 months to 15 years.
Main Outcome Measures:
Pain, deafness, and other symptoms related to acute otitis media or antibiotic treatment.
Results:
60% of placebo treated children were pain free within 24 hours of presentation, and antibiotics did not influence this. However, at 2-7 days after presentation, by which time only 14% of children in control groups still had pain, early use of antibiotics reduced the risk of pain by 41% (95% confidence interval 14% to 60%). Antibiotics reduced contralateral acute otitis media by 43% (9% to 64%). They seemed to have no influence on subsequent attacks of otitis media or deafness at one month, although there was a trend for improvement of deafness at three months. Antibiotics were associated with a near doubling of the risk of vomiting, diarrhoea, or rashes (odds ratio 1.97 (1.19 to 3.25)).
Conclusions:
Early use of antibiotics provides only modest benefit for acute otitis media: to prevent one child from experiencing pain by 2-7 days after presentation, 17 children must be treated with antibiotics early.