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

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Abstract

Background

This overview critically evaluates the available evidence The Cochrane Library offers on the treatment of acute otitis media (AOM). AOM is one of the most common clinical problems in childhood with peak incidence occurring in the first two years of life.

Objectives

To summarize Cochrane reviews that assess the effects of treatments for AOM in children.

Methods

The Cochrane Library was searched using the terms ‘otitis media’ and ‘ear infection’. Those reviews focusing on the treatment of AOM in children were included. Data on patient relevant outcomes (pain, treatment failure, AOM recurrence, and adverse events) were extracted by two authors.

Main Results

Five reviews were included in this overview. In the first review, antibiotics were compared with placebo. Although it appeared from the reports reviewed that antibiotics have marginal efficacy (number needed to treat = 12; number needed to harm = 12), because the reviewed studies included mostly older children with mild AOM, the results can not be generalized to young children or to children with severe AOM. In the second review, short (<7 days) and long courses of antibiotics were compared. Although the data were limited, shorter courses resulted in an increased likelihood of treatment failure [odds ratio (OR): 1.34, 95% confidence interval (CI): 1.16, 1.55]. In the third review, once-daily administration of antibiotics was compared with two- or three-times-daily administration. Although no significant differences were noted, the quality of the original data on which the review was based was less than optimal. In the fourth review, decongestants and/or antihistamines were compared with placebo. Decongestants and antihistamines provided no appreciable benefit and were associated with significant adverse events (OR: 7.34, 95% CI: 1.67, 32.25). In the fifth review, topical analgesic drops and placebo were compared in two small studies. Use of analgesic drops was associated with significant reductions in pain level (OR: 3.07, 95% CI: 1.33, 7.05 for pain reduction of ≥ 50%).

Authors' Conclusions

Additional well-designed trials in children of various age groups with AOM are needed to determine the efficacy of 1) standard-course antibiotic treatment, 2) short-course vs standard-course antibiotic treatment, and 3) topical analgesia. Limited evidence suggests that the use of decongestants and/or antihistamines in children with AOM should be avoided. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

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