title: Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial.
abstract: OBJECTIVE
  To identify which children with acute otitis media are at risk of poor outcome and to assess benefit from antibiotics in these children.
  
  
  METHODS
  Secondary analysis of randomised controlled trial cohort.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  315 children aged 6 months to 10 years.
  
  
  METHODS
  Immediate or delayed (taken after 72 hours if necessary) antibiotics.
  
  
  METHODS
  Predictors of short term outcome: an episode of distress or night disturbance three days after child saw doctor.
  
  
  RESULTS
  Distress by day three was more likely in children with high temperature (adjusted odds ratio 4.5, 95% confidence interval 2.3 to 9.0), vomiting (2.6,1.3 to 5.0), and cough (2.0, 1.1 to 3.8) on day one. Night disturbance by day three was more likely with high temperature 2.4 (1.2 to 4.8), vomiting (2.1,1.1 to 4.0), cough (2.3,1.3 to 4.2), and ear discharge (2.1, 1.2 to 3.9). Among the children with high temperature or vomiting, distress by day three was less likely with immediate antibiotics (32% for immediate v 53% for delayed, chi2=4.0; P=0.045, number needed to treat 5) as was night disturbance (26% v 59%, chi2=9.3; P=0.002; number needed to treat 3). In children without higher temperature or vomiting, immediate antibiotics made little difference to distress by day three (15% v 19%, chi2=0.74; P=0.39) or night disturbance (20% v 27%, chi2=1.6; P=0.20). Addition of cough did not significantly improve prediction of benefit.
  
  
  CONCLUSIONS
  In children with otitis media but without fever and vomiting antibiotic treatment has little benefit and a poor outcome is unlikely.
authors.affiliation: Community Clinical Sciences (Primary Medical Care Group), University of Southampton, Aldermoor Health Centre, Southampton SO15 6ST. psl3@soton.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Clare
authors.initials: C
authors.lastname: Gould
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
authors.forename: Greg
authors.initials: G
authors.lastname: Warner
authors.forename: Joan
authors.initials: J
authors.lastname: Dunleavey
authors.forename: Ian
authors.initials: I
authors.lastname: Williamson
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000209:etiology; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D010033:Otitis Media / Q000150:complications / Q000188:drug therapy*; D018579:Patient Selection; D011320:Primary Health Care / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents