FROM:
British Medical Journal 1997 (May 24); 314 (7093): 1526–1529 ~ FULL-TEXT
Christopher Del Mar, Paul Glasziou, Mauricio Hayem
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 randomized 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.
