title: Short-course antibiotics for acute otitis media.
abstract: BACKGROUND
  Acute otitis media (AOM) is a common illness during childhood, for which antibiotics are frequently prescribed.
  
  
  OBJECTIVE
  To determine the effectiveness of a short course of antibiotics (less than seven days) in comparison to a long course of antibiotics (seven days or greater) for the treatment of AOM in children.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 4) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE, EMBASE, MEDLINE In-Process & Other Non-Indexed Citations, CINAHL, BIOSIS Previews, OCLC Papers First and Proceedings First, Proquest Dissertations and Theses (inception to November 2009); International Pharmaceutical Abstracts, the NLM Gateway, ClinicalTrials.gov and Current Controlled Trials (inception to August 2008).
  
  
  METHODS
  Trials were included if they met the following criteria: participants aged one month to 18 years; clinical diagnosis of ear infection; no previous antimicrobial therapy; and randomisation to treatment with less than seven days versus seven days or more of antibiotics.
  
  
  METHODS
  The primary outcome of treatment failure was defined as the absence of clinical resolution, relapse or recurrence of AOM during one month following initiation of therapy. Treatment outcomes were extracted from individual studies and combined in the form of a summary odds ratio (OR). A summary OR of 1.0 indicates that the treatment failure rate following less than seven days of antibiotic treatment was similar to the failure rate following seven days or more of treatment.
  
  
  RESULTS
  This update included 49 trials containing 12,045 participants. Risk of treatment failure was higher with short courses of antibiotics (OR 1.34, 95% CI 1.15 to 1.55) at one month after initiation of therapy (21% failure with short-course treatment and 18% with long-course; absolute difference of 3% between groups). There were no differences found when examining treatment with ceftriaxone for less than seven days (30% failure in those receiving ceftriaxone and 27% in short-acting antibiotics administered for seven days or more) or azithromycin for less than seven days (18% failure in both those receiving azithromycin and short-acting antibiotics administered for seven days or more) with respect to risk of treatment failure at one month or less. Significant reductions in gastrointestinal adverse events were observed for treatment with short-acting antibiotics and azithromycin.
  
  
  CONCLUSIONS
  Clinicians need to evaluate whether the minimal short-term benefit from longer treatment of antibiotics is worth exposing children to a longer course of antibiotics.
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 8226a Aberhart Centre, 11402 University Ave, Edmonton, Alberta, Canada, T6G 2J3.
authors.forename: Anita
authors.initials: A
authors.lastname: Kozyrskyj
authors.forename: Terry P
authors.initials: TP
authors.lastname: Klassen
authors.forename: Michael
authors.initials: M
authors.lastname: Moffatt
authors.forename: Krystal
authors.initials: K
authors.lastname: Harvey
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D002443:Ceftriaxone / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D004334:Drug Administration Schedule; D006801:Humans; D010033:Otitis Media / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D017963:Azithromycin
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