http://bmj.com/cgi/content/abstract/325/7354/22
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 Collections under
which this article appears: Children
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Paul Little
a Community Clinical Sciences (Primary Medical Care Group), University of Southampton, Aldermoor Health Centre, Southampton SO15 6ST, b Three Swans Surgery, Salisbury, Wiltshire SP1 1DX, c Nightingale Surgery, Romsey, Hampshire SO51 7QN
Correspondence to: P Little
psl3@soton.ac.uk
Objectives: To identify which children with acute otitis
media are at risk of poor outcome and to assess benefit from antibiotics
in these children.
Design: Secondary analysis of randomised controlled trial
cohort.
Setting: Primary care.
Participants: 315 children aged 6 months to 10 years.
Intervention: Immediate or delayed (taken after 72 hours if
necessary) antibiotics.
Main outcome measure: Predictors of short term outcome: an episode
of distress or night disturbance three days after child saw
doctor.
Results: Distress by day three was more likely in children
with high temperature (adjusted odds ratio 4.5, 95% confidence
interval 2.3 to 9.0), vomiting (2.6,1.3 to 5.0), and cough (2.0, 1.1 to
3.8) on day one. Night disturbance by day three was more likely with
high temperature 2.4 (1.2 to 4.8), vomiting (2.1,1.1 to 4.0), cough
(2.3,1.3 to 4.2), and ear discharge (2.1, 1.2 to 3.9). Among the
children with high temperature or vomiting, distress by day three was
less likely with immediate antibiotics (32% for immediate v
53% for delayed, 
2=4.0;
P=0.045, number needed to treat 5) as was night disturbance (26% v
59%, 2=9.3; P=0.002;
number needed to treat 3). In children without higher temperature or
vomiting, immediate antibiotics made little difference to distress by
day three (15% v 19%, 2=0.74;
P=0.39) or night disturbance (20% v 27%,
2=1.6; P=0.20). Addition
of cough did not significantly improve prediction of
benefit.
Conclusion: In children with otitis media but without fever
and vomiting antibiotic treatment has little benefit and a poor
outcome is unlikely.
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What is already known on this topic It is unclear which children are more likely to benefit from antibiotics and which features predict poor outcome What this study adds Children with high temperature or vomiting were more likely to benefit from antibiotics, although it is still reasonable to wait 24-48 hours as many children will settle anyway Children without high temperature or vomiting were unlikely to have poor outcome and unlikely to benefit from immediate antibiotics |
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