Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial

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Primary care

Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial

Paul Little, clinician scientist, ^a Clare Gould, research assistant, ^a Michael Moore, general practitioner, ^b Greg Warner, general practitioner, ^c Joan Dunleavey, research coordinator, ^a Ian Williamson, senior lecturer. ^a

^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 antibioticsin thesechildren.
Design: Secondary analysis of randomised controlledtrialcohort.
Setting: Primarycare.
Participants: 315 children aged 6 months to 10years.
Intervention: Immediate or delayed (taken after 72 hoursif necessary)antibiotics.
Main outcome measure: Predictors of short term outcome: an episodeof 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 morelikely with high temperature 2.4 (1.2 to 4.8), vomiting (2.1,1.1to 4.0), cough (2.3,1.3 to 4.2), and ear discharge (2.1, 1.2 to3.9). Among the children with high temperature or vomiting, distressby day three was less likely with immediate antibiotics (32% forimmediate 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 withouthigher temperature or vomiting, immediate antibiotics made littledifference 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 improveprediction of benefit.
Conclusion: In children with otitis media but withoutfever and vomiting antibiotic treatment has little benefit anda poor outcome isunlikely.

What is already known on this topic
Most children with otitis media will not benefit symptomatically from immediate use of antibiotics

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 be distressed or have night disturbance three days after seeing the doctor

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

© BMJ 2002

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Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial

Primary care

Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial

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