Acute otitis media in children
Acute otitis media (AOM) is one of the most common infections in (early) childhood. It is defined as the presence of middle-ear effusion in conjunction with rapid onset of one or more signs or symptoms of inflammation of the middle ear such as fever, otalgia, and ear discharge (otorrhoea). Uncomplicated AOM is limited to the middle-ear cleft.
Focus of the review
This review includes evidence on the effectiveness and safety of the following interventions for a single episode of acute otitis media: analgesics, short-courses of (delayed and immediate) antibiotics (in specific subgroups of children), longer courses of antibiotics, and myringotomy.
Comments on evidence
Although analgesics are recognised as the cornerstone of treatment of AOM in children, we found only low-quality evidence on the effectiveness and safety of paracetamol, non-steroidal anti-inflammatory drugs, and topical anaesthetic ear drops. The quality of evidence regarding the effectiveness and safety of antibiotics was assessed as being of low to moderate using a GRADE evaluation. The quality of studies comparing different antibiotics with each other was judged to be very low.
Search and appraisal summary
The update literature search for this review was carried out from the date of the last search, September 2009, to October 2013. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the review, please see the Methods section. Searching of electronic databases retrieved 197 studies. After deduplication and removal of conference abstracts, 110 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 73 studies and the further review of 37 full publications. Of the 37 full articles evaluated, four systematic reviews and one RCT were included at this update.
Analgesics are likely to be beneficial in children with AOM but current evidence is of low-quality. The benefits and harms of antibiotic treatment should be carefully balanced, especially since AOM symptoms settle spontaneously within 3 days in 80% of children. Antibiotics seem most effective in children aged less than 2 years with bilateral AOM and in children with AOM presenting with ear discharge.
Substantive changes at this update
Analgesics (paracetamol, NSAIDs, topical anaesthetic ear drops) One systematic review updated. Categorisation unchanged (likely to be beneficial).
Antibiotics versus placebo Evidence re-evaluated. One systematic review updated. Categorisation unchanged (trade-off between benefits and harms).
Type of antimicrobial agent (antibiotic regimen) Title of option changed from 'Choice of antibiotic regimen' to 'Type of antimicrobial agent (antibiotic regimen)'. One systematic review updated, one RCT added. Categorisation unchanged (trade-off between benefits and harms).
Immediate versus delayed antibiotic treatment One systematic review updated. Categorisation unchanged (trade-off between benefits and harms).
INTRODUCTION: Acute otitis media (AOM) is a common reason for primary care visits in children. Yet, there is considerable debate on the most effective treatment. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments (analgesics, antibiotics, and myringotomy) in children with AOM? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 17 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics, antibiotics, delayed antibiotics, immediate antibiotics, longer courses of antibiotics, and myringotomy.