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Treatment of acute otitis media with a shortened course of antibiotics: a meta-analysis
A L Kozyrskyj1, G E Hildes-Ripstein, S E Longstaffe
1Department of Community Health Sciences, Manitoba Centre for Health Policy and Evaluation, University of Manitoba, Winnipeg, Canada.
Insights
Five days of short-acting antibiotics effectively treat acute otitis media in children. Shorter antibiotic courses demonstrate comparable outcomes to longer durations for this common childhood infection.
Area of Science:
- Pediatric infectious diseases
- Pharmacological treatment of otitis media
Background:
- Acute otitis media (AOM) is a common childhood infection requiring antibiotic treatment.
- Standard antibiotic durations for AOM have historically been 7-10 days, but shorter courses are increasingly explored.
Purpose of the Study:
- To conduct a meta-analysis of randomized controlled trials (RCTs) comparing short-term (less than 7 days) versus long-term (at least 7 days) antibiotic treatment for AOM in children.
- To determine if treatment outcomes are comparable between different antibiotic durations.
Main Methods:
- Systematic literature search of MEDLINE, EMBASE, Current Contents, and Science Citation Index (1966-1997).
- Inclusion criteria: RCTs in children (4 weeks to 18 years) with AOM, no prior antimicrobial therapy, and randomization to <7 days vs. ≥7 days antibiotic treatment.
- Outcomes extracted included treatment failures, relapses, and reinfections; methodological quality was assessed.
Main Results:
- The meta-analysis included trials of short-acting oral antibiotics (penicillin, amoxicillin, cephalosporins), intramuscular ceftriaxone, and oral azithromycin.
- For short-acting oral antibiotics, 5-day courses showed comparable outcomes to 8-10 day courses by 20-30 days post-treatment (OR, 1.22; 95% CI, 0.98-1.54).
- Comparable outcomes were observed between short-term and long-term antibiotic use for ceftriaxone, azithromycin, and other oral antibiotics up to 3 months.
Conclusions:
- Five-day courses of short-acting antibiotics are effective for uncomplicated acute otitis media in children.
- Shorter antibiotic durations appear to be a viable and effective treatment strategy for AOM, potentially reducing antibiotic exposure.
Objective:
To conduct a meta-analysis of randomized controlled trials of antibiotic treatment of acute otitis media in children to determine whether outcomes were comparable in children treated with antibiotics for less than 7 days or at least 7 days or more.
Data Sources:
MEDLINE (1966-1997), EMBASE (1974-1997), Current Contents, and Science Citation Index searches were conducted to identify randomized controlled trials of the treatment of acute otitis media in children with antibiotics of different durations.
Study Selection:
Studies were included if they met the following criteria: subjects aged 4 weeks to 18 years, clinical diagnosis of acute otitis media, no antimicrobial therapy at time of diagnosis, and randomization to less than 7 days of antibiotic treatment vs 7 days or more of antibiotic treatment.
Data Extraction:
Trial methodological quality was assessed independently by 7 reviewers; outcomes were extracted as the number of treatment failures, relapses, or reinfections.
Data Synthesis:
Included trials were grouped by antibiotic used in the short course: (1) 15 short-acting oral antibiotic trials (penicillin V potassium, amoxicillin [-clavulanate], cefaclor, cefixime, cefuroxime, cefpodoxime proxetil, cefprozil), (2) 4 intramuscularceftriaxone sodium trials, and (3) 11 oral azithromycin trials. The summary odds ratio for treatment outcomes at 8 to 19 days in children treated with short-acting antibiotics for 5 days vs 8 to 10 days was 1.52 (95% confidence interval [CI], 1.17-1.98) but by 20 to 30 days outcomes between treatment groups were comparable (odds ratio, 1.22; 95% CI, 0.98 to 1.54). The risk difference (2.3%; 95% CI,-0.2% to 4.9%) at 20 to 30 days suggests that 44 children would need to be treated with the long course of short-acting antibiotics to avoid 1 treatment failure. This similarity in later outcomes was observed for up to 3 months following therapy (odds ratio, 1.16; 95% CI, 0.90-1.50). Comparable outcomes were shown between treatment with ceftriaxone or azithromycin, and at least 7 days of other antibiotics.
Conclusion:
This meta-analysis suggests that 5 days of short-acting antibiotic use is effective treatment for uncomplicated acute otitis media in children.