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Review
. 2010 Sep 8;2010(9):CD001095.
doi: 10.1002/14651858.CD001095.pub2.

Short-course Antibiotics for Acute Otitis Media

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Free PMC article
Review

Short-course Antibiotics for Acute Otitis Media

Anita Kozyrskyj et al. Cochrane Database Syst Rev. .
Free PMC article

Abstract

Background: Acute otitis media (AOM) is a common illness during childhood, for which antibiotics are frequently prescribed.

Objectives: To determine the effectiveness of a short course of antibiotics (less than seven days) in comparison to a long course of antibiotics (seven days or greater) for the treatment of AOM in children.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 4) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE, EMBASE, MEDLINE In-Process & Other Non-Indexed Citations, CINAHL, BIOSIS Previews, OCLC Papers First and Proceedings First, Proquest Dissertations and Theses (inception to November 2009); International Pharmaceutical Abstracts, the NLM Gateway, ClinicalTrials.gov and Current Controlled Trials (inception to August 2008).

Selection criteria: Trials were included if they met the following criteria: participants aged one month to 18 years; clinical diagnosis of ear infection; no previous antimicrobial therapy; and randomisation to treatment with less than seven days versus seven days or more of antibiotics.

Data collection and analysis: The primary outcome of treatment failure was defined as the absence of clinical resolution, relapse or recurrence of AOM during one month following initiation of therapy. Treatment outcomes were extracted from individual studies and combined in the form of a summary odds ratio (OR). A summary OR of 1.0 indicates that the treatment failure rate following less than seven days of antibiotic treatment was similar to the failure rate following seven days or more of treatment.

Main results: This update included 49 trials containing 12,045 participants. Risk of treatment failure was higher with short courses of antibiotics (OR 1.34, 95% CI 1.15 to 1.55) at one month after initiation of therapy (21% failure with short-course treatment and 18% with long-course; absolute difference of 3% between groups). There were no differences found when examining treatment with ceftriaxone for less than seven days (30% failure in those receiving ceftriaxone and 27% in short-acting antibiotics administered for seven days or more) or azithromycin for less than seven days (18% failure in both those receiving azithromycin and short-acting antibiotics administered for seven days or more) with respect to risk of treatment failure at one month or less. Significant reductions in gastrointestinal adverse events were observed for treatment with short-acting antibiotics and azithromycin.

Authors' conclusions: Clinicians need to evaluate whether the minimal short-term benefit from longer treatment of antibiotics is worth exposing children to a longer course of antibiotics.

Conflict of interest statement

None.

Figures

1
1
Funnel plot of comparison: 2 Short‐acting antibiotic > 48 hours short‐term treatment, outcome: 2.1 Treatment failure at 1 month or less.
2
2
Funnel plot of comparison: 21 Ceftriaxone, outcome: 21.1 Treatment failure at 1 month or less.
3
3
Funnel plot of comparison: 23 Azithromycin 3 to 5 days short‐term treatment, outcome: 23.1 Treatment failure at 1 month or less.
1.1
1.1. Analysis
Comparison 1 Short‐acting antibiotic =< 48 hours in short treatment arm, Outcome 1 Treatment failure at 1 month or less.
2.1
2.1. Analysis
Comparison 2 Short‐acting antibiotic > 48 hours short‐term treatment, Outcome 1 Treatment failure at 1 month or less.
2.2
2.2. Analysis
Comparison 2 Short‐acting antibiotic > 48 hours short‐term treatment, Outcome 2 Treatment failure at 8 to 19 days.
2.3
2.3. Analysis
Comparison 2 Short‐acting antibiotic > 48 hours short‐term treatment, Outcome 3 Treatment failure at 20 to 30 days.
2.4
2.4. Analysis
Comparison 2 Short‐acting antibiotic > 48 hours short‐term treatment, Outcome 4 Treatment failure at 3 months or less.
2.5
2.5. Analysis
Comparison 2 Short‐acting antibiotic > 48 hours short‐term treatment, Outcome 5 Treatment failure at 90 days.
2.6
2.6. Analysis
Comparison 2 Short‐acting antibiotic > 48 hours short‐term treatment, Outcome 6 Treatment failure at 30 to 45 days.
3.1
3.1. Analysis
Comparison 3 Short‐acting antibiotic > 48 hours short‐term treatment, < 2 yrs old, Outcome 1 Treatment failure at 1 month or less.
4.1
4.1. Analysis
Comparison 4 Short‐acting antibiotic > 48 hours short‐term treatment, => 2 yrs old, Outcome 1 Treatment failure at 1 month or less.
5.1
5.1. Analysis
Comparison 5 Short‐acting antibiotic > 48 hours short‐term treatment, perforated eardrum, Outcome 1 Treatment failure at 1 month or less.
6.1
6.1. Analysis
Comparison 6 Short‐acting antibiotic > 48 hours short‐term treatment, non‐perforated eardrum, Outcome 1 Treatment failure at 1 month or less.
7.1
7.1. Analysis
Comparison 7 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity Analysis: include chronic OM, Outcome 1 Treatment failure at 1 month or less.
7.2
7.2. Analysis
Comparison 7 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity Analysis: include chronic OM, Outcome 2 Treatment failure at 20 to 30 days.
8.1
8.1. Analysis
Comparison 8 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity Analysis: exclude chronic OM, Outcome 1 Treatment failure at 1 month or less.
8.2
8.2. Analysis
Comparison 8 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity Analysis: exclude chronic OM, Outcome 2 Treatment failure at 20 to 30 days.
9.1
9.1. Analysis
Comparison 9 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: outcome only if "cured", Outcome 1 Treatment failure at 1 month or less.
9.2
9.2. Analysis
Comparison 9 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: outcome only if "cured", Outcome 2 Treatment failure at 20 to 30 days.
10.1
10.1. Analysis
Comparison 10 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: same antibiotic in treatment arms, Outcome 1 Treatment failure at 1 month or less.
10.2
10.2. Analysis
Comparison 10 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: same antibiotic in treatment arms, Outcome 2 Treatment failure at 8 to 19 days.
10.3
10.3. Analysis
Comparison 10 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: same antibiotic in treatment arms, Outcome 3 Treatment failure at 20 to 30 days.
10.4
10.4. Analysis
Comparison 10 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: same antibiotic in treatment arms, Outcome 4 Treatment failure at 3 months or less.
10.5
10.5. Analysis
Comparison 10 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: same antibiotic in treatment arms, Outcome 5 Treatment failure at 90 days.
10.6
10.6. Analysis
Comparison 10 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: same antibiotic in treatment arms, Outcome 6 Treatment failure at 30 to 45 days.
11.1
11.1. Analysis
Comparison 11 Short‐acting antibiotic > 48 hours short‐term treatment, excluding amoxicillin‐clavulanate, Outcome 1 Gastrointestinal adverse effects.
12.1
12.1. Analysis
Comparison 12 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: treatment failure at 1 month or less and risk of bias, Outcome 1 Sensitivity analysis: allocation concealment unclear risk of bias.
12.2
12.2. Analysis
Comparison 12 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: treatment failure at 1 month or less and risk of bias, Outcome 2 Sensitivity analysis: allocation concealment low risk of bias.
12.3
12.3. Analysis
Comparison 12 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: treatment failure at 1 month or less and risk of bias, Outcome 3 Sensitivity analysis: blinding high and unclear risk of bias.
12.4
12.4. Analysis
Comparison 12 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis: treatment failure at 1 month or less and risk of bias, Outcome 4 Sensitivity analysis: blinding low risk of bias.
13.1
13.1. Analysis
Comparison 13 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis amoxil‐clav. both arms, Outcome 1 Amoxil‐clav. 5 versus 10 days, treatment failure 1 month or less.
13.2
13.2. Analysis
Comparison 13 Short‐acting antibiotic > 48 hours short‐term treatment; Sensitivity analysis amoxil‐clav. both arms, Outcome 2 Excluding amoxil‐clav. 5 versus 10 days, treatment failure 1 month or less.
14.1
14.1. Analysis
Comparison 14 Short‐acting antibiotic > 48 hours short‐term treatment, => 2 yrs old; Sensitivity analysis, Outcome 1 Treatment failure at 1 month or less.
15.1
15.1. Analysis
Comparison 15 Short‐acting antibiotic > 48 hours short‐term treatment, < 2 yrs old; Sensitivity analysis, Outcome 1 Treatment failure at 1 month or less.
16.1
16.1. Analysis
Comparison 16 Short‐acting antibiotic, > 48 hours short‐term treatment, adverse GI effects, Outcome 1 Gastrointestinal adverse effects.
17.1
17.1. Analysis
Comparison 17 Ceftriaxone, Outcome 1 Treatment failure at 1 month or less.
17.2
17.2. Analysis
Comparison 17 Ceftriaxone, Outcome 2 Treatment failure at 3 months or less.
17.3
17.3. Analysis
Comparison 17 Ceftriaxone, Outcome 3 Gastrointestinal adverse effects.
18.1
18.1. Analysis
Comparison 18 Azithromycin single‐dose short‐term treatment, Outcome 1 Treatment failure at 25 to 32 days.
18.2
18.2. Analysis
Comparison 18 Azithromycin single‐dose short‐term treatment, Outcome 2 Treatment failure at 25 to 32 days, =< 2 yrs old.
18.3
18.3. Analysis
Comparison 18 Azithromycin single‐dose short‐term treatment, Outcome 3 Treatment failure at 25 to 32 days, > 2 yrs old.
18.4
18.4. Analysis
Comparison 18 Azithromycin single‐dose short‐term treatment, Outcome 4 Gastrointestinal adverse effects.
19.1
19.1. Analysis
Comparison 19 Azithromycin 3 to 5 days short‐term treatment, Outcome 1 Treatment failure at 1 month or less.
19.2
19.2. Analysis
Comparison 19 Azithromycin 3 to 5 days short‐term treatment, Outcome 2 Treatment failure at 8 to 19 days.
19.3
19.3. Analysis
Comparison 19 Azithromycin 3 to 5 days short‐term treatment, Outcome 3 Treatment failure at 20 to 30 days.
20.1
20.1. Analysis
Comparison 20 Azithromycin 3 to 5 days short‐term treatment, < 2 years old, Outcome 1 Treatment failure at 1 month or less.
21.1
21.1. Analysis
Comparison 21 Azithromycin 3 to 5 days short‐term treatment, => 2 years old, Outcome 1 Treatment failure at 1 month or less.
22.1
22.1. Analysis
Comparison 22 Azithromycin 3‐5 days short‐term treatment; Sensitivity analysis: include chronic OM, Outcome 1 Treatment failure at 1 month or less.
22.2
22.2. Analysis
Comparison 22 Azithromycin 3‐5 days short‐term treatment; Sensitivity analysis: include chronic OM, Outcome 2 Treatment failure at 20 to 30 days.
23.1
23.1. Analysis
Comparison 23 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: exclude chronic OM, Outcome 1 Treatment failure at 1 month or less.
23.2
23.2. Analysis
Comparison 23 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: exclude chronic OM, Outcome 2 Treatment failure at 20 to 30 days.
24.1
24.1. Analysis
Comparison 24 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: outcome only if "cured", Outcome 1 Treatment failure at 1 month or less.
24.2
24.2. Analysis
Comparison 24 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: outcome only if "cured", Outcome 2 Treatment failure at 20 to 30 days.
25.1
25.1. Analysis
Comparison 25 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: similar spectrum antibiotic in treatment arms, Outcome 1 Treatment failure at 20 to 30 days.
25.2
25.2. Analysis
Comparison 25 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: similar spectrum antibiotic in treatment arms, Outcome 2 Treatment failure at 1 month or less.
26.1
26.1. Analysis
Comparison 26 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: risk of bias, Outcome 1 Sensitivity analysis: allocation concealment unclear or high risk of bias.
26.2
26.2. Analysis
Comparison 26 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: risk of bias, Outcome 2 Sensitivity analysis: allocation concealment low risk of bias.
26.3
26.3. Analysis
Comparison 26 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: risk of bias, Outcome 3 Sensitivity analysis: blinding high and unclear risk of bias.
26.4
26.4. Analysis
Comparison 26 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: risk of bias, Outcome 4 Sensitivity analysis: blinding low risk of bias.
27.1
27.1. Analysis
Comparison 27 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: industry funding, Outcome 1 Treatment failure 1 month or less.
27.2
27.2. Analysis
Comparison 27 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: industry funding, Outcome 2 Treatment failure at 8 to 19.
27.3
27.3. Analysis
Comparison 27 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: industry funding, Outcome 3 Treatment failure at 20 to 30 days.
28.1
28.1. Analysis
Comparison 28 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: funding not reported, Outcome 1 Treatment failure 1 month or less.
28.2
28.2. Analysis
Comparison 28 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: funding not reported, Outcome 2 Treatment failure at 8 to 19 days.
28.3
28.3. Analysis
Comparison 28 Azithromycin 3 to 5 days short‐term treatment; Sensitivity analysis: funding not reported, Outcome 3 Treatment failure at 20 to 30 days.
29.1
29.1. Analysis
Comparison 29 Azithromycin 3 to 5 days short‐term treatment, adverse GI effects, Outcome 1 Gastrointestinal adverse effects.
30.1
30.1. Analysis
Comparison 30 Methods ‐ combined control group versus twice counting tx, Outcome 1 Twice counting ‐ short‐acting antibiotic > 48 hours short‐term treatment, treatment failure at 1 month or less.
30.2
30.2. Analysis
Comparison 30 Methods ‐ combined control group versus twice counting tx, Outcome 2 Combined control groups ‐ short‐acting antibiotic > 48 hours short‐term treatment, treatment failure 1 month or less.
30.3
30.3. Analysis
Comparison 30 Methods ‐ combined control group versus twice counting tx, Outcome 3 Twice counting ‐ short‐acting antibiotic > 48 hours short‐term treatment, treatment failure at 1 to 19 days.
30.4
30.4. Analysis
Comparison 30 Methods ‐ combined control group versus twice counting tx, Outcome 4 Combined control groups ‐ short‐acting antibiotic > 48 hours short‐term treatment, treatment failure 1 to 19 days.
30.5
30.5. Analysis
Comparison 30 Methods ‐ combined control group versus twice counting tx, Outcome 5 Twice counting ‐ short‐acting antibiotic > 48 hours short‐term treatment, treatment failure 20 to 30 days.
30.6
30.6. Analysis
Comparison 30 Methods ‐ combined control group versus twice counting tx, Outcome 6 Combined control groups ‐ short‐acting antibiotic > 48 hours short‐term treatment, treatment failure at 20 to 30 days.
30.7
30.7. Analysis
Comparison 30 Methods ‐ combined control group versus twice counting tx, Outcome 7 Twice counting ‐ short‐acting antibiotic > 48 hours short‐term treatment, treatment failure at 30 to 40 days.
30.8
30.8. Analysis
Comparison 30 Methods ‐ combined control group versus twice counting tx, Outcome 8 Combined control groups ‐ short‐acting antibiotic > 48 hours short‐term treatment, treatment failure 30 to 40 days.
30.9
30.9. Analysis
Comparison 30 Methods ‐ combined control group versus twice counting tx, Outcome 9 Twice counting ‐ short‐acting antibiotic > 48 hours short‐term treatment, treatment failure at 3 months or less.
30.10
30.10. Analysis
Comparison 30 Methods ‐ combined control group versus twice counting tx, Outcome 10 Combined control groups ‐ short‐acting antibiotic > 48 hours short‐term treatment, treatment failure at 3 months or less.

Update of

  • Short course antibiotics for acute otitis media.
    Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SE, Wincott JL, Sitar DS, Klassen TP, Moffatt ME. Kozyrskyj AL, et al. Cochrane Database Syst Rev. 2000;(2):CD001095. doi: 10.1002/14651858.CD001095. Cochrane Database Syst Rev. 2000. PMID: 10796591 Updated. Review.

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