TREATMENT OF ACUTE OTITIS-MEDIA WITH A SHORTENED COURSE OF ANTIBIOTICS - A METAANALYSIS

Objective.-To conduct a meta-analysis of randomized controlled trials of antibiotic treatment of acute otitis media in children to determine whether outcomes were comparable in children treated with antibiotics for less than 7 days or at least 7 days or more. Data Sources.-MEDLIN E (1966-1997), EMBASE (1974-1997), Current Contents, and Science Citat ion Index searches were conducted to identify randomized controlled tr ials of the treatment of acute otitis media in children with antibioti cs of different durations, Study Selection.-Studies were included if t hey met the following criteria: subjects aged 4 weeks to 18 years, cli nical diagnosis of acute otitis media, no antimicrobial therapy at tim e of diagnosis, and randomization to less than 7 days of antibiotic tr eatment vs 7 days or more of antibiotic treatment, Data Extraction.-Tr ial methodological quality was assessed independently by 7 reviewers; outcomes were extracted as the number of treatment failures, relapses, or reinfections. Data Synthesis.-Included trials were grouped by anti biotic used in the short course: (1) 15 short-acting oral antibiotic t rials (penicillin V potassium, amoxicillin [-clavulanate], cefaclor, c efixime, cefuroxime, cefpodoxime proxetil, cefprozil), (2)4 intramuscu lar ceftriaxone sodium trials, and (3) 1 1 oral azithromycin trials. T he summary odds ratio for treatment outcomes at 8 to 19 days in childr en treated with short-acting antibiotics for 5 days vs 8 to 10 days wa s 1.52 (95% confidence interval [CI], 1.17-1.98) but by 20 to 30 days outcomes between treatment groups were comparable (odds ratio, 1.22; 9 5% CI, 0.98 to 1.54). The risk difference (2.3%; 95% CI, -0.2% to 4.9% ) at 20 to 30 days suggests that 44 children would need to be treated with the long course of short-acting antibiotics to avoid 1 treatment failure. This similarity in later outcomes was observed for up to 3 mo nths following therapy (odds ratio, 1.16; 95% CI, 0.90-1.50), Comparab le outcomes were shown between treatment with ceftriaxone or azithromy cin, and at least 7 days of other antibiotics, Conclusion. This meta-a nalysis suggests that 5 days of short-acting antibiotic use is effecti ve treatment for uncomplicated acute otitis media in children.