You are here

Article Text

Article menu

Download PDFPDF

Best evidence topic report
Antibiotics for otitis media
Free
  1. Angaj Ghosh,
  2. Rupert Jackson
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M139WL, UK

    http://dx.doi.org/10.1136/emj.18.2.123

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      Report by Angaj Ghosh, Senior Clinical Fellow Search checked by Rupert Jackson, Specialist Registrar

      Clinical scenario

      A 2 year old child is brought into the emergency department with general malaise and irritability for the past 24 hours. Examination of the right ear reveals a diffusely red bulging ear drum.A diagnosis of acute otitis media is made. You wonder whether there is any evidence that oral antibiotics would decrease the time to recovery and prevent secondary complications.

      Three part question

      In [a systemically well child with otitis media] are [oral antibiotics better than placebo] at [decreasing time to recovery and reducing the incidence of secondary complications]?

      Search strategy

      Medline 1966–11/00 using the OVID interface. Cochrane database. [(exp otitis media OR otitis media.mp OR acute otitis media.mp OR acute red ear.mp) AND (exp antibiotics OR antibiotic$.mp OR exp amoxycillin OR amoxycillin.mp OR exp amoxicillin-potassium clavulanate combination OR augmentin.mp OR co-amoxyclav.mp OR exp erythromycin OR exp erythromycin estolate OR erythromycin.mp OR exp penicillins OR penicillin.mp OR non-antibiotic treatment.mp OR placebo.mp)] AND maximally sensitive RCT filter LIMIT to human AND english.

      Search outcome

      Altogether 865 papers found of which 10 were relevant and had been meta-analysed by the Cochrane review group, which was last updated on the 28 April 2000. No further relevant papers have been published since. A meta-analysis done in 1994 was also selected. Details are shown in table 8.

      View this table:
      Table 8

      Comments

      Most cases of otitis media will spontaneously resolve.

      Clinical bottom line

      There is some benefit from the use of antibiotics in otitis media.

      Report by Angaj Ghosh, Senior Clinical Fellow Search checked by Rupert Jackson, Specialist Registrar

      References

      1. Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr1994;124:355–67.
        OpenUrlCrossRefPubMedWeb of Science
      2. Glasziou PP, Del Mar CB, Hayem M. Antibiotics for acute otitis media in children (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.