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

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    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 OR acute otitis OR acute red AND (exp antibiotics OR antibiotic$.mp OR exp amoxycillin OR OR exp amoxicillin-potassium clavulanate combination OR OR OR exp erythromycin OR exp erythromycin estolate OR OR exp penicillins OR OR non-antibiotic OR] 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.

    Table 8


    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