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Acute otitis media

Acute otitis media is a common reason for children being brought to their GP. Most children experience at least one episode by the time they are seven years old. Acute otitis media is one of the most common reasons for prescribing antibiotics, but the value of prescribing antibiotics is increasingly questioned, especially now with concerns about increasing antibiotic resistance.

Despite this, there are often pressures to prescribe antibiotics and reasons why such prescribing may be appropriate. One question which then arises is whether to go for a course of antibiotics over 10 days or so, or whether a short course of five days or less may be equally efficacious. A new meta-analysis of trials answers the question [ 1 ].


A search sought randomised trials comparing different durations of antibiotic treatment in children with a diagnosis of acute otitis media. Searching was thorough, and process issues were well addressed. Thirty-two trials were found and included, including 17 with short-acting antibiotics (eg penicillin V potassium, amoxicillin), four with ceftriaxone sodium, and 11 with azithromycin.


The outcomes used were treatment failure at 8-19 days and at 20-30 days.


The meta-analysis used Cochrane review methods, reporting odds ratios with no individual trial information, making it difficult to plot results or describe actual rates of success or failure, and Bandolier has a problem with odds ratios anyway. Summarising the main results, therefore:


This is a thorough review, with many sub-group and sensitivity analyses. None detract from the main findings, that long courses of antibiotics confer little, if any, benefit over short courses. The fact that there is a benefit at 8-16 days is probably more of a reflection of the fact that the long course is only just completed and does not allow for any recurrence in the time.


  1. AL Kozyrskyi, GE Hildes-Ripstein, SE Longstaffe et al. Treatment of acute otitis media with a shortened course of antibiotics. JAMA 1998 279: 1736-42.

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