Antibiotics for acute otitis media: a meta-analysis with individual patient data

Maroeska M. Rovers, Paul Glasziou, Cees L. Appelman, Peter Burke, David P. McCormick, Roger A. Damoiseaux, Isabelle Gaboury, Paul Little, Arno W. Hoes

Research output: Contribution to journalArticle

211 Scopus citations

Abstract

Background: Individual trials to test effectiveness of antibiotics in children with acute otitis media have been too small for valid subgroup analyses. We aimed to identify subgroups of children who would and would not benefit more than others from treatment with antibiotics. Methods: We did a meta-analysis of data from six randomised trials of the effects of antibiotics in children with acute otitis media. Individual patient data from 1643 children aged from 6 months to 12 years were validated and re-analysed. We defined the primary outcome as an extended course of acute otitis media, consisting of pain, fever, or both at 3-7 days. Findings: Significant effect modifications were noted for otorrhoea, and for age and bilateral acute otitis media. In children younger than 2 years of age with bilateral acute otitis media, 55% of controls and 30% on antibiotics still had pain, fever, or both at 3-7 days, with a rate difference between these groups of -25% (95% CI -36% to -14%), resulting in a number-needed-to-treat (NNT) of four children. We identified no significant differences for age alone. In children with otorrhoea the rate difference and NNT, respectively, were -36% (-53% to -19%) and three, whereas in children without otorrhoea the equivalent values were -14% (-23% to -5%) and eight. Interpretation: Antibiotics seem to be most beneficial in children younger than 2 years of age with bilateral acute otitis media, and in children with both acute otitis media and otorrhoea. For most other children with mild disease an observational policy seems justified.

Original languageEnglish (US)
Pages (from-to)1429-1435
Number of pages7
JournalLancet
Volume368
Issue number9545
DOIs
StatePublished - Oct 21 2006

    Fingerprint

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rovers, M. M., Glasziou, P., Appelman, C. L., Burke, P., McCormick, D. P., Damoiseaux, R. A., Gaboury, I., Little, P., & Hoes, A. W. (2006). Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet, 368(9545), 1429-1435. https://doi.org/10.1016/S0140-6736(06)69606-2