USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS-MEDIA AND IN TREATING OTITIS-MEDIA WITH EFFUSION - A METAANALYTIC ATTEMPT TO RESOLVE THE BROUHAHA
Rl. Williams et al., USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS-MEDIA AND IN TREATING OTITIS-MEDIA WITH EFFUSION - A METAANALYTIC ATTEMPT TO RESOLVE THE BROUHAHA, JAMA, the journal of the American Medical Association, 270(11), 1993, pp. 1344-1351
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.