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Antibiotics for Otitis Media in Children

 

Am Fam Physician. 2018 Jun 15;97(12):online.

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ANTIBIOTICS FOR OTITIS MEDIA IN CHILDREN

BenefitsHarms

None had less pain at 24 hours

1 in 14 developed adverse effects such as vomiting, diarrhea, or rash

1 in 7 to 20 had decreased pain after the first 24 hours (based on the time of assessment from days 2 to 12)

None avoided recurrence of infection or hearing loss at 3 months

1 in 33 avoided tympanic membrane perforation

1 in 11 avoided contralateral ear infection

None avoided serious complications (e.g., mastoiditis or meningitis)

ANTIBIOTICS FOR OTITIS MEDIA IN CHILDREN

BenefitsHarms

None had less pain at 24 hours

1 in 14 developed adverse effects such as vomiting, diarrhea, or rash

1 in 7 to 20 had decreased pain after the first 24 hours (based on the time of assessment from days 2 to 12)

None avoided recurrence of infection or hearing loss at 3 months

1 in 33 avoided tympanic membrane perforation

1 in 11 avoided contralateral ear infection

None avoided serious complications (e.g., mastoiditis or meningitis)

Details for This Review

Study Population: Children between two months and 15 years of age from high-income countries enrolled in 13 randomized controlled trials (3,401 participants)1

Efficacy End Points: Pain at various time points (24 hours, two to three days, four to seven days, 10 to 12 days), tympanic membrane (eardrum) perforation, contralateral ear infection (in unilateral ear infections), recurrence of ear infection, hearing loss (decreased hearing) after three months

Harm End Points: Medication adverse effects such as vomiting, diarrhea, or rash; serious consequences of ear infection such as mastoiditis or meningitis

Narrative: Acute otitis media is a disease that most commonly affects young infants and children. The inflammation and edema caused by the infection can manifest as ear pain or ear fullness, typically accompanied by fever, irritability, and decreased activity and feeding. Complications include tympanic membrane perforation with otorrhea, hearing loss, and recurrent otitis media. More severe complications include mastoiditis, cranial nerve palsies, and meningitis.

Currently, there are no universally accepted guidelines pertaining to the use of antibiotics in children diagnosed with otitis media. The guidelines published by the American Academy of Pediatrics recommend antibiotic prescription for children six months and older with severe signs and symptoms of acute otitis media (moderate to severe otalgia, otalgia for 48 hours or more, or temperature of 102.2°F [39°C] or higher).2 For nonsevere unilateral otitis media, the same guidelines recommend antibiotic treatment or close follow-up based on joint decision-making with parents or caregivers. However, treatment patterns for otitis media differ among physicians. Some prescribe antibiotics liberally, whereas others take a more conservative approach by observing patients for worsening symptoms

Author disclosure: No relevant financial affiliations.

References

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1. Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2015;(6):CD000219....

2. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media [published correction appears in Pediatrics. 2014; 133(2): 346]. Pediatrics. 2013;131(3):e964–e999.

3. Rovers MM, Glasziou P, Appelman CL, et al. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet. 2006;368(9545):1429–1435.

4. Berman S. Otitis media in developing countries. Pediatrics. 1995;96(1pt 1):126–131.

5. Rothman R, Owens T, Simel DL. Does this child have acute otitis media? JAMA. 2003;290(12):1633–1640.

 

 

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