Antibiotics are modestly more effective than no treatment for middle ear infections in children

Research Activities, July 2011, No. 371

Middle ear infections (acute otitis media, AOM) are the most common infection for which children receive antibiotics in the United States. In addition, the management of AOM costs an estimated $2.8 billion dollars per year. California researchers recently reviewed the literature to examine evidence for the diagnosis and treatment of AOM in children. They found that antibiotic treatment for uncomplicated AOM in low-risk children may have a slightly better success rate compared with no antibiotic treatment. However, it is also associated with an increased risk of side effects such as rash or diarrhea.

The analysis included 135 studies published from 1999 through 2010. The findings from one systemic review and three additional studies on diagnosis suggested that specific visual signs (red and immobile or bulging tympanic membrane) when examining the ear with an otoscope were strongly associated with AOM and critical for accurate diagnosis. Symptoms such as ear rubbing, pain, and fever were less important in predicting the condition. Six studies shed light on changes in the microbiology of AOM after the introduction of the heptavalent pneumoccocal vaccine (PCV-7) in 2000. In general, Haemophilus influenzae became more prevalent as the cause of AOM compared with Streptococcus pneumoniae, although the latter organism remained an important cause. Seven randomized controlled trials compared ampicillin or amoxicillin with placebo and reported on clinical success. Pooling the data from these studies, the difference in the success rate by day 14 of illness was 12 percent; that is, 9 children would need to be treated with immediate ampicillin or amoxicillin in order to see one case of clinical success from using immediate antibiotic treatment.

There was also an increased rate of side effects with treatment with amoxicillin or ampicillin compared with placebo, with a 3 to 5 percent increase in the rate of rash or diarrhea. Further, there was no evidence that any other antibiotics work better at treating AOM than amoxicillin, the currently recommended first-choice antibiotic for AOM. The study was supported in part by the Agency for Healthcare Research and Quality (Contract No. 290-07-10056).

See "Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children," by Tumaini R. Coker, M.D., M.B.A., Linda S. Chan, Ph.D., Sydne J. Newberry, Ph.D., and others in the Journal of the American Medical Association 304(19), pp. 2161-2169, 2010.

Current as of July 2011
Internet Citation: Antibiotics are modestly more effective than no treatment for middle ear infections in children: Research Activities, July 2011, No. 371. July 2011. Agency for Healthcare Research and Quality, Rockville, MD.