LANDMARK: Antibiotic use for otitis media with effusion in pediatric patients

Article: Antibiotics for otitis media with effusion in children: A Cochrane Systematic Review

Van zon A, Van der heijden GJ, Van dongen TM, Burton MJ, Schilder AG. Antibiotics for otitis media with effusion in children. Cochrane Database Syst Rev. 2012;(9):CD009163.

 

Take home points

  • Systematic review on the effectiveness of oral antibiotics in children with otitis media effusion (OME)
  • Children treated with oral antibiotics are more likely to have complete resolution at two to three months (moderate quality evidence)
  • Children treated with oral antibiotics are also more likely to experience diarrhea, vomiting or skin rash (low quality evidence)
  • No association with fewer ventilation tube insertions, Impact on short term hearing is uncertain, no data on speech, language, and cognitive development.
  • Results of the review do not support routine use of antibiotics for OME

 

The Details:

  • Systematic review
    • Includes randomized controlled trials (RTC)- 23 trials, 3258 children
    • Children aged 18 or under with dx of unilateral or bilateral OME
    • Excluded- children with tubes present, chronic suppurative otitis media, known immunodeficiency, down syndrome, or craniofacial anomalies
    • Intervention- oral antibiotics of any kind
    • Primary outcomes
      • Complete resolution of OME at two-three months post randomization, adverse effects- diarrhea, vomiting, skin rash
    • Secondary outcomes
      • Complete resolution of OME at various points, hearing, language and speech, cognitive development, QOL, insertion of ventilation tubes, TM sequelae, AOM episodes
  • Results
    • 61% of studies, 14/23 treated for 10 to 14 days
    • 61% included children under 2 years old
    • Figure 4: Oral antibiotics more likely to have complete resolution of OME at 2-3 months post randomization
      • RR 2.00, 95% CI 1.58 to 2.53, Number needed to treat to benefit = 5
    • Figure 5: Adverse Effects including diarrhea, vomiting and skin rash
      • RR 2.15, 95% CI 1.29 to 3.60, Number needed to treat to harm = 20

Summary contributed by Sahil Patel