Objectives: To assess the effectiveness of antibiotics in the clinical management of children with acute otitis media.Search strategy: The literature from 1958 to 1994 was systematically searched to identify studies which looked at whether antibiotics reduce symptoms and complications of acute otitis media
Selection criteria: Studies were included if they were (a) randomised and (b) involved the use of one or more antibiotics against a control that did not receive antibiotics.
Data collection and analysis: From the eight identified trials we extracted data on duration of symptoms, hearing problems, and complications.
Main results: Our primary interests were in (a) short-term relief of symptoms and (b) subsequent complications.
Results: The eight trials, all in developed countries, suggest no reduction in pain at 24 hours, but a 41% relative reduction in pain at 2-7 days. Since approximately 80% of patients will have settled spontaneously in this time, this means an absolute reduction of about 8%, that is about 12 children must be treated with antibiotics to prevent 1 child having some pain after 2 days. There was no effect of antibiotics on complication rates, as measured by subsequent tympanometry or recurrence. However, there were few serious complications seen in these trials: only one case of mastoiditis occurred (in a penicillin treated group).
Conclusions: Antibiotics provide a real but small benefit in acute otitis media in children. As most cases will resolve spontaneously, this poses a difficult decision for clinicians when weighed against the possible adverse reactions. For populations or subgroups at risk of suppurative complications such as mastoiditis, e.g., in developing countries, antibiotics would be strongly advised.