Acute otitis media |
||
|
|
Despite this, there are often pressures to prescribe antibiotics and reasons why such prescribing may be appropriate. One question which then arises is whether to go for a course of antibiotics over 10 days or so, or whether a short course of five days or less may be equally efficacious. A new meta-analysis of trials answers the question [ 1 ].
Review
A search sought randomised trials comparing different durations of antibiotic treatment in children with a diagnosis of acute otitis media. Searching was thorough, and process issues were well addressed. Thirty-two trials were found and included, including 17 with short-acting antibiotics (eg penicillin V potassium, amoxicillin), four with ceftriaxone sodium, and 11 with azithromycin.
Outcomes
The outcomes used were treatment failure at 8-19 days and at 20-30 days.
Results
The meta-analysis used Cochrane review methods, reporting odds ratios with no individual trial information, making it difficult to plot results or describe actual rates of success or failure, and Bandolier has a problem with odds ratios anyway. Summarising the main results, therefore:
- At 8-19 days, longer courses of antibiotics had a lower rate of treatment failure, with a difference in risk of 7.8%. Thus the number needed to treat to experience an additional failure with short-acting antibiotics was 13 (95% confidence interval 8.6 to 25). The odds ratio was significantly in favour of the longer course at 1.52 (95% confidence interval 1.17 to 1.98) using results from 1524 children analysed.
- At 20-30 days, longer courses of antibiotics also had a lower rate of treatment failure, but with a difference in risk of only 2.3%. Thus the number needed to treat to experience an additional failure with short-acting antibiotics was 43 (95% confidence interval 20 to no benefit). But there was no statistically significant difference, with an odds ratio of 1.22 (95% confidence interval 0.98 to 1.54) in results from 2115 children analysed.
Comment
This is a thorough review, with many sub-group and sensitivity analyses. None detract from the main findings, that long courses of antibiotics confer little, if any, benefit over short courses. The fact that there is a benefit at 8-16 days is probably more of a reflection of the fact that the long course is only just completed and does not allow for any recurrence in the time.
Reference:
- AL Kozyrskyi, GE Hildes-Ripstein, SE Longstaffe et al. Treatment of acute otitis media with a shortened course of antibiotics. JAMA 1998 279: 1736-42.