Efficacy of Short Course (<4 Days) of Antibiotics for Treatment of Acute Otitis Media in Children: A Systematic Review of Randomized Controlled Trials.
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Date
2010-01
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Abstract
Objective: To determine the efficacy of a short course of
antibiotics (<4 days) in comparison to a longer course (≥4
days) for the treatment of acute otitis media in children.
Data sources: Electronic databases, hand search of
reviews, bibliographies of books, abstracts and
proceedings of international conferences.
Review Methods: Randomized controlled trials of the
empiric treatment of acute otitis media comparing
antibiotic regimens of <4 days versus ≥4 days in children
between four weeks to eighteen years of age were
included. The trials were grouped by pharmacokinetic
behavior of short-course antibiotics into short-acting
antibiotics, parenteral ceftriaxone, and long-acting
azithromycin.
Results: We reviewed 35 trials, which provided 38
analytic components. Overall, there was no evidence of an
increased risk of treatment failure until one month with a short-course of antibiotics (RR=1.06, 95% CI 0.95 to 1.17,
P=0.298). Use of short-acting oral antibiotic in shortcourse
was associated with a significantly increased risk
of treatment failure (RR=2.27, 95% CI: 1.04 to 4.99). There
was a slightly increased risk of treatment failure with
parenteral ceftriaxone (RR=1.13, 95% CI 0.99 to 1.30).
The risk of adverse effects was significantly lower with
short-course regimens (RR=0.58, 95% CI: 0.48 to 0.70).
Conclusion: There is no evidence of an increased risk of
treatment failure with short course of antibiotics for acute
otitis media. Among the short-course regimens,
azithromycin use was associated with a lower risk of
treatment failure while short-acting oral antibiotics and
parenteral ceftriaxone may be associated with a higher
risk of treatment failure.
Description
Keywords
Acute otitis media, Antibiotics, Children, Management, Short-course therapy, Systematic review
Citation
Gulani Anjana, Sachdev H P S, Qazi Shamim A. Efficacy of Short Course (<4 Days) of Antibiotics for Treatment of Acute Otitis Media in Children: A Systematic Review of Randomized Controlled Trials. Indian Pediatrics. 2010 Jan; 47(1): 74-87.