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Otitis media symptoms reduced by antibiotics

By News team

Antibiotics reduce the symptoms of otitis media, two studies published in the New England Journal of Medicine show.

The findings have led one commentator, Jerome Klein, of the department of paediatrics, Boston University School of Medicine, Boston, Massachusetts, to say that doctors should consider that antibiotics could be used to treat otitis media in all young children where diagnosis is certain (NEJM 2011; 364:168).

However, the researchers behind one of the papers (ibid p105) advise restricting use of antibiotics in this population to minimise unnecessary use and bacterial resistance with the other paper’s researchers (ibid p116) suggesting that future studies should identify patients who will get the greatest benefit from treatment, in order to minimise unnecessary treatment and the development of bacterial resistance.

In the first paper, 291 children aged six to 23 months with acute otitis media were randomised to receive either amoxicillin and clavulanic acid or placebo for 10 days.

Of those on active treatment 35 per cent had symptom improvement by day 2, 61 per cent by day 4, and 80 per cent by day 7. This was in comparison with those on placebo where 28 per cent had improvement by day 2, 54 per cent by day 4, and 74 per cent by day 7 (P=0.14 for the overall comparison).

Patients receiving the antibiotic also had higher levels of sustained symptom resolution at days 2, 4 and 7 compared with placebo (P=0.04 for the overall comparison).

In the second paper, 319 children aged six to 35 months with acute otitis media were treated with amoxicillin and clavulanic acid or placebo for seven days.

Treatment failure — otoscopic signs of acute otitis media, condition of child and adverse events — occurred in more children taking placebo than taking the antibiotic (44.9 per cent versus 18.6 per cent, P<0.001)

Overall, amoxicillin and clavulanic acid reduced treatment failure by 62 per cent (hazard ratio 0.38, 95 per cent confidence interval 0.25-0.59; P<0.001) and the need for rescue treatment by 81 per cent (HR 0.19, CI, 0.10-0.36; P<0.001).

However, more children receiving antibiotics suffered from diarrhoea and eczema.

Citation: The Pharmaceutical Journal URI: 11061122

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