USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS-MEDIA AND IN TREATING OTITIS-MEDIA WITH EFFUSION - A METAANALYTIC ATTEMPT TO RESOLVE THE BROUHAHA

Objective.-To determine the efficacy of antibiotics for prophylaxis of recurrent otitis media and treatment of otitis media with effusion (O ME) in children.Data Sources.-MEDLINE from 1966 through April 1993, te xtbooks, Current Contents, and bibliographies of selected articles. St udy Selection.-Thirty-three studies initially identified were reviewed by three blinded reviewers assessing study quality and suitability fo r inclusion. Twenty-seven met inclusion criteria for the meta-analyses . Data Extraction.-We abstracted quantitative data and calculated rate differences (RDs) using tympanometry as the preferred outcome measure . Data Synthesis.-Nine studies of antibiotic prophylaxis of recurrent otitis media with 958 subjects had an RD of 0.11 (95% confidence inter val [CI], 0.03 to 0.1 9) favoring antibiotic treatment. Twelve studies of short-term patient outcomes of OME with 1697 subjects had an RD fa voring antibiotics of 0.16 (95% CI, 0.03 to 0.29), while eight studies using the ear as the outcome measure with 2052 ears studied had an RD of 0.25 (95% CI, 0.10 to 0.40). No significant difference was shown b etween placebo and antibiotics (RD, 0.06; 95% CI, -0.03 to 0.14) in th e eight studies of longer-term outcome of OME. Subgroup analyses by an tibiotic grouping, duration of treatment, and duration of disease did not show significant differences. Conclusions.-Antibiotics appear to h ave beneficial but limited effect on recurrent otitis media and short- term resolution of OME. Longer-term benefit for OME has not been shown . The findings are limited by the failure of most studies to consider potential confounders and by inability to identify groups of patients most likely to benefit.