AHRQ released a new evidence report on treating children immediately for uncomplicated otitis media with amoxicillin produces a modest benefit compared to placebo or a delay in using antibiotics. The authors, led by Paul G. Shekelle, M.D., Ph.D., of AHRQ’s Southern California Evidence-Based Practice Center in Santa Monica, also found that doing so may increase the likelihood of diarrhea and rash. The review found no evidence that any other antibiotic is superior to amoxicillin for success in treating uncomplicated acute otitis media; that symptoms such as a red, immobile, or bulging eardrum are critical to diagnosis, but the lack of a gold standard for diagnosing acute otitis media currently makes drawing firm conclusions about the precision of diagnostic methods difficult; and that the heptavalent Pneumococcal Conjugate Vaccine (PCV7) has had an impact on microbial epidemiology. The review also found that long-term use of antibiotics in children prone to the disease decreases episodes by about half, but drawbacks, such as diarrhea, allergic reactions, and the emergence of bacterial resistance should be weighed against the risk of the ear infection's recurrence. AHRQ’s report was requested by the American Academy of Pediatrics. Select to access the report, Management of Acute Otitis Media: Update. Acute Otitis Media, Update (see below)
Full Title: Management of Acute Otitis Media: Update
November 2010
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Structured Abstract
Context: Acute Otitis Media (AOM), a viral or bacterial infection of the ear, is the most common childhood infection for which antibiotics are prescribed in the United States. In 2001, the Southern California Evidence-based Practice Center conducted a systematic review of the evidence comparing treatments of AOM.
Objectives: This review updates the 2001 review findings on diagnosis and treatment of uncomplicated AOM, assesses the evidence for treatment of recurrent AOM, and assesses the impact of the heptavalent pneumococcal conjugate (PCV7) vaccine on the microbiology of AOM.
Data Sources and Study Selection: Searches of PubMed® and the Cochrane databases were conducted from January 1998 to July 2010 using the same search strategies used for the 2001 report, with the addition of terms not considered in the 2001 review. The Web of Science was also searched for citations of the 2001 report and its peer-reviewed publications.
Data Extraction: After review by two investigators against pre-determined inclusion/exclusion criteria, we included existing systematic reviews and randomized controlled clinical trials for assessment of treatment efficacy and safety. Pooled analysis was performed for comparisons with three or more trials.
Results and Conclusions: Few studies were found that examined the accuracy and precision of the diagnosis of AOM. Since PCV7's introduction, AOM microbiology has shifted significantly, with Streptococcus pneumoniae becoming less prevalent and Haemophilus influenzae (HF) increasing in importance. For uncomplicated AOM, pooled analysis indicates that nine children (95% CI: 6, 20) would need to be treated with ampicillin or amoxicillin rather than placebo to note a difference in the rate of clinical success. However, in four studies of delayed treatment approaches for uncomplicated AOM, two had higher rates of clinical success with immediate antibiotic therapy while two did not, and in three studies, a marked decrease in antibiotic utilization was noted. We are unable to draw definitive conclusions regarding the comparative effectiveness of different antibiotics for AOM in children with recurrent otitis media (ROM). For ROM, long-term antibiotic administration will decrease AOM episodes from 3 to 1.5 for every 12 months of treatment per otitis prone child during active treatment (95% CI: 1.2, 2.1); however, potential consequences of long-term treatment need to be considered. Data were insufficient to draw conclusions about comparative effectiveness of different treatment strategies in subgroups of children with uncomplicated AOM. Adverse events were generally more frequent for amoxicillin-clavulanate than for cefdinir, ceftriaxone, or azithromycin. Higher quality studies and improved reporting of study characteristics related to quality are needed to provide definitive conclusions for AOM and ROM treatment options.
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Download Report
Management of Acute Otitis Media: Update
•Evidence Report (Publication No. No. 11-E004). (PDF File, 6.2 MB) PDF Help.
http://www.ahrq.gov/downloads/pub/evidence/pdf/otitis/otitisup.pdf
Evidence-based Practice Center: RAND
Topic Nominators: American Academy of Pediatrics (AAP)
Current as of November 2010
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Internet Citation:
Management of Acute Otitis Media: Update, Structured Abstract. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/clinic/tp/otitisuptp.htm
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Management of Acute Otitis Media: Update: Structured Abstract
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