Implications of the AHRQ evidence report on acute otitis media

OBJECTIVE. To familiarize otolaryngologists with the Agency for Healthcare Research and Quality (AHRQ) Evidence Report on Acute Otitis Media (AOM) tha t reviews the natural history and role of antibiotics in management. The re port, by the Southern California Evidence-Based Practice Center (SC-EPC), i s the most recent of 15 literature syntheses published by the AHRQ. DATA SOURCES: MEDLINE (1966 to present), Cochrane Library, EMBASE, BIOSIS, HealthSTAR, and other computerized databases; manual reference search of pr oceedings, articles, reports, and guidelines. STUDY SELECTION: Randomized trials and cohort studies relevant to the natur al history of AOM and the efficacy of antimicrobial therapy. AOM was define d by the 11-member technical expert panel (including 2 authors, RMR and MLC ) as middle-ear effusion with the rapid onset of signs or symptoms of middl e ear inflammation. DATA EXTRACTION: Two physician reviewers at the Southern California. Eviden ce-Based Practice Center independently rated the articles and extracted dat a. DATA SYNTHESIS: Children receiving placebo or no antimicrobial had a poo led clinical success rate of 81% at 1 to 7 days (95% Cl, 72% to 90%), with no increase in suppurative complications when followed closely. Amoxicillin or ampicillin increased the absolute success rate by 12.3% (95% Cl, 2.8% t o 21.8%) in 5 studies pooled using random effects meta-analysis. The antimi crobial benefit was robust to sensitivity analysis. In contrast, success ra tes were not influenced by the choice or duration of therapy. CONCLUSIONS: The AHRQ report emphasizes middle-ear effusion as a preeminent criteria for AOM diagnosis and provides extensive evidence tables on natur al history and antimicrobial impact. About 8 children must receive antibiot ics to avoid I clinical failure, but children younger than age 2 years or w ith severe symptoms may benefit more. The report is a starting point for or ganizations seeking to develop AOM guidelines, performance measures, and ot her quality improvement tools.