Acute Otitis Media

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Acute Otitis Media
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Acute Otitis MediaClinical Evidence. Neill O, et
al. Search date Jan 2006

• Acute otitis media (AOM) is a common condition
  for which antibiotics are frequently prescribed
• In the UK 30 of children under 3 years of age
  visit their general practitioner with AOM each
  year, and 97 receive antimicrobial treatment.
  10 of children have had an episode of AOM by the
  age of 3 months
• Diagnosing AOM based on signs and symptoms is not
  clear-cut but ear pain, a cloudy, bulging or red
  tympanic membrane may help with diagnosis
• The most common bacterial cause of otitis media
  are  Streptococcus pneumoniae, Haemophilus
  influenzae, and Moraxella catarrhalis.
• 60 of children will improve within 24 hours and
  80 resolve in about 3 days without antibiotic
  treatment
• Serious complications are rare in otherwise
  healthy children but include hearing loss,
  mastoiditis, meningitis, and recurrent attacks

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Treatment of AOMClinical Evidence. Neill O, et
al. Search date Jan 2006

• Analgesia. Paracetamol (NNT 6) and ibuprofen
  (NNT5) are effective in relieving ear ache but
  not other symptoms of AOM (appearance of the
  tympanic membrane rectal temperature and
  parental assessment of appetite, sleep, and
  playing activity)
• Antibiotics.
• 7 patients in 100 will gain extra pain relief at
  27 days with antibiotics. There is evidence
  that younger patients (under 2 years) may benefit
  more. In the same patient group, 6 extra children
  will experience harms such as diarrhoea, vomiting
  or rash
• It is not possible to identify which patients
  will gain extra pain relief and which will suffer
  increased harms from antibiotic treatment
• Antibiotics had no effect on pain outcomes at 24
  hours nor the rate of subsequent recurrence of
  AOM or abnormal tympanometry at 1 month or at 3
  months

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Treatment of AOM

• Antibiotics identifying who benefits most.
  Little P, et al. BMJ 200232522
• In this paper, benefit for antibiotics in terms
  of distress at day 3 and night disturbance was
  seen only in children who also had high
  temperature (NNT 5) and vomiting (NNT 3)
• Other treatments Cochrane review. Glazsiou PP,
  et al. Issue 3, 2004
• No benefit for other treatments except possibly
  for decongestants and antihistamines in
  combination (but caution due to subgroup
  analysis). All other treatments showed a 58 fold
  increase in side effects

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What about delayed prescriptions? Little P, et
al. BMJ 200132233642. 36/150 of those
allocated to delayed treatment reported taking
the antibiotics. Significantly fewer children in
the delayed group had diarrhoea.
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Summary

• Antibiotics should not be used routinely for AOM
• Harms and benefits of antibiotic treatment should
  be carefully weighed up
• Those that benefit most from antibiotics may be
  children with high temperature and vomiting or
  younger patients
• Simple analgesia should help relieve ear pain
• A delayed prescription may be a useful option
  where clinical symptoms or parental pressure
  warrant it