Antibiotics Offer Limited Benefit for Children With Acute Otitis Media

WESTPORT, CT (Reuters Health) Aug 06 - Most uncomplicated cases of acute otitis media in children resolve spontaneously without complications, according to a review of literature published between 1966 and 1999. Amoxicillin and ampicillin were found to provide "modest benefit" in relieving symptoms.

Dr. Glenn S. Takata, of Childrens Hospital in Los Angeles, and colleagues reviewed 74 reports of randomized, controlled trials that addressed acute otitis media in children ages 4 weeks to 18 years old. Their findings appear in the August issue of Pediatrics.

The investigators found that, overall, signs and symptoms resolved within 4 to 7 days in 78% of children not initially treated with antibiotics. Based on a subanalysis of six studies that compared ampicillin or amoxicillin with placebo, they estimate that "about eight children with acute otitis media would need to be treated with ampicillin or amoxicillin to reap the benefit of avoiding a clinical failure" at days 2 to 7.

The efficacy of various drugs and dosing regimens was similar, Dr. Takata's team determined. However, the incidence of adverse gastrointestinal effects varied, with children receiving cefixime more likely to experience diarrhea than those receiving amoxicillin. A 5-day course of azithromycin was associated with fewer adverse events than 7 to 10 days of amoxicillin-clavulanate.

Pediatrics 2001;108:239-247.