The Cochrane Library and acute otitis media in children: an overview of reviews

Background: Acute otitis media (AOM) is one of the most common clinical problems in childhood with peak\ud incidence occurring in the first 2 years of life.\ud Objectives: To critically evaluate the available evidence in The Cochrane Library regarding the treatment\ud of AOM.\ud \ud Methods: The Cochrane Library was searched using the terms ‘otitis media’ and ‘ear infection’. Reviews\ud focusing on the treatment of AOM in children were included. Data on patient relevant outcomes (pain, treatment\ud failure, AOM recurrence and adverse events) were extracted by two authors.\ud \ud Main results: Six reviews were included in this overview. The first review compared antibiotics with placebo.\ud Antibiotics reduced pain on days 2–7 [odds ratio (OR): 0.61; 95% confidence interval (CI): 0.49–0.75; Number\ud needed to treat (NNT) = 14] but increased overall adverse events (OR: 2.35; 95% CI: 1.14–4.84; NNT = 7).\ud Antibiotics also reduced the number of children with treatment failure (persistence of signs and symptoms\ud at the end of therapy) (OR: 0.40; 95% CI: 0.27–0.60; NNT = 8), and this effect was larger in two recent\ud randomized controlled trials which used stringent diagnostic criteria and were restricted to young children (OR: 0.24; 95% CI: 0.16–0.34; NNT = 4). The second review addressing the length of antibiotic treatment showed\ud that shorter courses of oral antibiotics resulted in a slightly increased likelihood of treatment failure (OR: 1.34;95% CI: 1.16, 1.55), although trial quality was limited. In the third review, no significant differences were noted between once- or twice-daily versus three times-daily administration of amoxicillin-based antibiotic treatment; however, the quality of the original data on which the review was based was less than optimal. The fourth\ud review compared delayed antibiotics to immediate therapy or to no antibiotics for AOM, with no differences\ud in pain between groups. In the fifth review, decongestants and/or antihistamines were compared with placebo.\ud Decongestants and antihistamines provided no appreciable benefit and were associated with significant adverse\ud events (OR: 3.74; 95% CI: 1.53, 9.16). In the sixth review, topical analgesic drops and placebo were compared.\ud Use of analgesic drops was associated with a significant increase in pain reduction (OR: 3.07; 95% CI: 1.33,\ud 7.05).\ud \ud Authors’ conclusions: Current evidence suggests that antibiotic treatment may be justified in young children\ud with stringently diagnosed AOM