Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis

Abstract 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. Key messages There is wide variation in the use of antibiotics for early treatment of acute otitis media in children, and we examined the literature by meta-analysis to establish what benefits or harm antibiotics provide Antibiotics did not influence resolution of pain within 24 hours of presentation, though 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 about 40% Antibiotics also reduced contralateral acute otitis media but seemed to have little influence on subsequent attacks of otitis media or deafness Antibiotics were associated with a near doubling of the risk of vomiting, diarrhoea, or rashes 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