Cochrane Review Summarizes Risks & Benefits
Acute otitis media (AOM) is characterized by the presence of middle ear effusions with an acute onset of signs and symptoms of middle ear inflammation for which antibiotics are commonly prescribed.
A Cochrane review from February 2023 updated the previous review on AOM and included 13 RCTs. The primary outcomes measured included: pain at different time points, and adverse effects from antibiotics. The secondary outcomes were: abnormal tympanometry, tympanic membrane perforation, contralateral otitis, AOM recurrences, serious complications of AOM, and long-term effects.
The results:
Antibiotics vs Placebo
Antibiotics do not reduce the number of children with pain at 24 hours and are only slightly more effective for pain in the days following
They do not reduce risk of late AOM recurrence
They do increase risk of adverse events: vomiting, diarrhea, rash
They do reduce the pain at 2-3 days by one third of children, and results in two-thirds fewer having pain at 10-12 days
Reduce risk of abnormal tympanometry findings at 4-6 weeks (but not at 6-8 weeks or at 3 months)
Slightly reduce risk of tympanic membrane perforations
Half the risk of contralateral otitis episodes
Immediate antibiotics vs. expectant observation
Immediate antibiotics may result in reduction of pain at 2-3 days (but not at 3-7 days or 11-14 days)
Immediate antibiotics increase the risk of vomiting, diarrhea, rash
They probably do not reduce the proportion of children with abnormal tympanometry findings at 4 weeks, may not reduce risk of TM perforation or recurrences
Bottom line:
Most children with AOM in high-income countries are justified in having an expectant observation approach
Emphasize adequate analgesia and a limited role for antibiotics
References
Venekamp RP, Sanders SL, Glasziou PP, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database of Systematic Reviews 2023, Issue 11. Art. No.: CD000219
Am Fam Physician. 2017;95(2):109-110
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