1 Acute Otitis Media

2 Acute Otitis Media Clinical 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

3 Treatment of AOM Clinical Evidence. Neill O, et al. Search date Jan 2006 Analgesia. Paracetamol (NNT = 6) and ibuprofen (NNT=5) 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 2–7 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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6 Treatment of AOM Antibiotics: identifying who benefits most. Little P, et al. BMJ 2002:325:22 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 5–8 fold increase in side effects

7 What about delayed prescriptions? Little P, et al. BMJ 2001;322:336–42. 36/150 of those allocated to delayed treatment reported taking the antibiotics. Significantly fewer children in the delayed group had diarrhoea.

8 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