A Cochrane review [Abstract] 1 included 9 studies with a total of 2 132 children aged 0-12 years. The included studies compared the effects and safety of a wide range of interventions in children with grommets who develop ear discharge beyond the immediate postoperative period. Two studies compared oral antibiotics to placebo or observation.Children treated with oral antibiotics (amoxicillin-clavulanate) were more likely to have resolution of ear discharge at less than 2 weeks than those treated with placebo (72% versus 33%; RR 2.21, 95% CI 1.36 to 3.60, NNTB 3; 1 study, n=79). The proportion of children with resolution of ear discharge at intermediate-term follow-up (2 weeks) did not differ significantly between children treated with oral antibiotics and those who did not receive treatment (RR 1.23, 95% CI 0.90 to 1.69; 1 study, n=154). Both studies showed a significant difference in the number of days with ear discharge in favour of oral antibiotics (median duration 3 versus 8 days and median duration 5 versus 12 days), although pooling of the results was not possible.
Comment: The quality of evidence is downgraded by imprecise results (few patients and outcome events), and by inconsistency (variability in results).
Another Cochrane review [Abstract] 2 included 15 RCTs with a total of 2476 children. They were aged from 4 months to 17 years. For a single application at surgery, there was evidence that at 2 weeks postoperatively the risk of otorrhoea was reduced by multiple saline washouts (from 30% to 16%; RR 0.52, 95%CI 0.27 to 1.00; NNTB 7; one RCT; n=140) and antibiotic/steroid ear drops (from 9% to 1%; RR 0.13, 95% CI 0.03 to 0.57; NNTB 13; one RCT; 322 ears). A meta-analysis of 2 trials (222 ears) failed to find an effect of a single application of antibiotic/steroid ear drops at 4 to 6 weeks postoperatively.For a prolonged application of an intervention, there was evidence from 4 trials that the risk of otorrhoea was reduced 2 weeks postoperatively by antibiotic ear drops (from 15% to 8%; RR 0.54, 95% CI 0.30 to 0.97; NNTB 15; one RCT, n=372), antibiotic/steroid ear drops (from 39% to 5%; RR 0.13, 95% CI 0.05 to 0.31; NNTB 3; one RCT, n=200), aminoglycoside/steroid ear drops (from 15% to 5%; RR 0.37, 95% CI 0.18 to 0.74; NNTB 11; one RCT, n=356) or oral antibacterial agents/steroids (from 39% to 5%; RR 0.13, 95% CI 0.03 to 0.51; NNTB 3; one RCT, n=77).
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions) and indirectness (short follow-up time).
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