Antibiotics for acute otitis media in children

Abstract (PubMed)

Background: Acute otitis media (AOM) is one of the most common childhood illnesses requiring medical consultation, and is the most common reason antibiotics are prescribed. Objectives: To assess the effects of antibiotics for children with AOM. Search methods: We searched CENTRAL (2015, Issue 3), MEDLINE (1966 to April 2015), EMBASE (1990 to April 2015), and other databases. Selection criteria: RCTs comparing antibiotics with placebo and immediate versus expectant observation in children with AOM. Main results: Thirteen RCTs (3,401 children) compared antibiotics versus placebo; five RCTs (1,149 children) compared immediate versus expectant antibiotics. For antibiotics versus placebo: at 2-3 days, one-third fewer children had pain (RR 0.70), tympanic membrane perforation was reduced 57% (NNTB 33), contralateral AOM was reduced (NNTB 11). NNT for children under 2 with bilateral AOM was 4; for children with AOM and otorrhoea, NNTB 3. Adverse effects (vomiting, diarrhoea, rash) occurred more with antibiotics (NNTH 14). For immediate versus expectant antibiotics: no significant difference in pain at 3-7 or 11-14 days. Author conclusions: For most children with mild AOM in high-income countries, an expectant observational approach seems justified. Antibiotics are most useful in children under 2 years with bilateral AOM or with both AOM and otorrhoea.