MANAGEMENT OF CHILDHOOD ACUTE OTITIS MEDIA WITH OR WITHOUT ORAL ANTIBIOTICS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Author(s)
Syed Ahmed Raza, MSc1, Thelma Ubani, MSc1, Omar Irfan, MD1, Liga Bennetts, PhD2, Gabriela Friedrich, MSc3, Pauline Le Nouveau, MSc4, Shaun Morris, MD, MPH, FRCPC, FAAP, DTM&H5;
1Amaris Consulting, Toronto, ON, Canada, 2Amaris Consulting, Montreal, QC, Canada, 3Amaris Consulting, Barcelona, Spain, 4Amaris Consulting, Nantes, France, 5The Hospital for Sick Children, Toronto, ON, Canada
1Amaris Consulting, Toronto, ON, Canada, 2Amaris Consulting, Montreal, QC, Canada, 3Amaris Consulting, Barcelona, Spain, 4Amaris Consulting, Nantes, France, 5The Hospital for Sick Children, Toronto, ON, Canada
OBJECTIVES: Acute otitis media (AOM), infection of the middle ear, is frequent in children. Given concerns regarding inappropriate antibiotic use, it is important to understand the extent to which children with AOM benefit from antibiotic treatment. This systematic literature review (SLR) was conducted to understand clinical outcomes of oral antibiotic use in children with AOM.
METHODS: We searched Embase, MEDLINE, MEDLINE In-Process, Cochrane databases for publications on randomized controlled trials (RCTs; April 2015-August 2023) and non-randomized studies (NRS; inception- July 2023). Published RCTs were also identified from a prior relevant SLR. Studies assessing oral antibiotic therapy against placebo/no antibiotic therapy for AOM in children (≤19 years) were included. Two reviewers screened publications. Studies were assessed using risk of bias tools (RoB 2, ROBINS-I). Meta-analyses were conducted with the Mantel-Haenszel method for pooling relative risk (RR) measures. Certainty of evidence (CoE) for pooled estimates was determined using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
RESULTS: Seventeen studies (13 RCTs, 4 NRS) were included. Reductions in pain at 2-3 days (RR: 0.71 [95% CI: 0.58, 0.88]; GRADE: High CoE) and 10-12 days (RR: 0.33 [95% CI: 0.17, 0.66]; GRADE: Low CoE) were observed after antibiotic treatment versus placebo. However, no such effect was observed at 24 hours or 3-7 days. Patients had higher rates of vomiting, diarrhea, and rash with antibiotics versus placebo (RR: 1.38 [95% CI: 1.16, 1.63]; GRADE: High CoE).
CONCLUSIONS: Benefits of antibiotic use must be weighed against risks identified in this study, in addition to the increased risk of resistance associated with antibiotic use.
METHODS: We searched Embase, MEDLINE, MEDLINE In-Process, Cochrane databases for publications on randomized controlled trials (RCTs; April 2015-August 2023) and non-randomized studies (NRS; inception- July 2023). Published RCTs were also identified from a prior relevant SLR. Studies assessing oral antibiotic therapy against placebo/no antibiotic therapy for AOM in children (≤19 years) were included. Two reviewers screened publications. Studies were assessed using risk of bias tools (RoB 2, ROBINS-I). Meta-analyses were conducted with the Mantel-Haenszel method for pooling relative risk (RR) measures. Certainty of evidence (CoE) for pooled estimates was determined using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
RESULTS: Seventeen studies (13 RCTs, 4 NRS) were included. Reductions in pain at 2-3 days (RR: 0.71 [95% CI: 0.58, 0.88]; GRADE: High CoE) and 10-12 days (RR: 0.33 [95% CI: 0.17, 0.66]; GRADE: Low CoE) were observed after antibiotic treatment versus placebo. However, no such effect was observed at 24 hours or 3-7 days. Patients had higher rates of vomiting, diarrhea, and rash with antibiotics versus placebo (RR: 1.38 [95% CI: 1.16, 1.63]; GRADE: High CoE).
CONCLUSIONS: Benefits of antibiotic use must be weighed against risks identified in this study, in addition to the increased risk of resistance associated with antibiotic use.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH211
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
SDC: Infectious Disease (non-vaccine), SDC: Pediatrics