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Evidence summaries

Antibiotics for the Prevention of Acute and Chronic Suppurative Otitis Media in Children

For children at risk, antibiotics given once or twice daily appear to reduce the probability of AOM while the child is on treatment. Level of evidence: "B"

The quality of evidence is downgraded by suspected publication bias (larger effect noted in small studies).

Summary

A Cochrane review [Abstract] 1 included 17 studies with a total of 1 586 subjects. All studies enrolled children at increased risk of AOM. The majority of the studies were of high quality. Long-term antibiotics (mainly amoxycillin or sulfisoxazole) reduced any episode of AOM (RR 0.65, 95% CI 0.53 to 0.79, statistical heterogeneity I2 =68%; 14 studies, n=1 461) and number of episodes of AOM (incidence rate ratio (IRR) 0.51, 95% CI 0.39 to 0.66, statistical heterogeneity I2 =73%; 13 studies, n=1 327), NNT = 5 to prevent one child experiencing AOM whilst on long-term treatment. Antibiotics prevented 1.5 episodes of AOM for every 12 months of treatment per child. Long-term antibiotics were associated with a statistically non-significant increase in adverse events (RR 1.99, 95% CI 0.25 to 15.89, statistical heterogeneity I2 =53%; 12 studies, n=817).

Comment: The possibility for and effects of the development of antibiotic resistance if antibiotic prophylaxis is widely practised is a major concern.

References

  • Leach AJ, Morris PS. Antibiotics for the prevention of acute and chronic suppurative otitis media in children. Cochrane Database Syst Rev 2006 Oct 18;(4):CD004401 [Review content assessed as up-to-date: 5 August 2010]. [PubMed]

Primary/Secondary Keywords