Short-course antibiotics for acute otitis media.
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.
Kozyrskyj
Anita
A
Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 8226a Aberhart Centre, 11402 University Ave, Edmonton, Alberta, Canada, T6G 2J3.
Klassen
Terry P
TP
Moffatt
Michael
M
Harvey
Krystal
K
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
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D017963:Azithromycin
Pediatr Infect Dis J. 2005 Jun;24(6):525-32
15933563
J Antimicrob Chemother. 1996 Jun;37 Suppl C:63-9
8818847
Cochrane Database Syst Rev. 2013 Jan 31;(1):CD000219
23440776
Br J Clin Pract. 1987 Jul;41(7):820-6
3446282
Pediatrics. 1997 Jul;100(1):157-8
9229709
Pediatr Infect Dis J. 2000 Dec;19(12 Suppl):S147-52
11144396
Control Clin Trials. 1986 Sep;7(3):177-88
3802833
Pediatr Infect Dis J. 1996 Feb;15(2):157-64
8822290
Pediatr Infect Dis J. 1997 May;16(5):463-70
9154538
Eur J Clin Microbiol Infect Dis. 1995 Aug;14(8):669-76
8565983
Chemotherapy. 1988;34 Suppl 1:39-46
3246170
Infez Med. 2004 Dec;12(4):259-65
15729016
Pediatr Infect Dis J. 1997 Jul;16(7):680-95
9239773
Pediatrics. 1995 Jul;96(1 Pt 1):5-13
7596722
Arch Pediatr Adolesc Med. 2008 Feb;162(2):111-6
18250233
BMJ. 1994 Nov 19;309(6965):1351-5
7866085
Br Med J (Clin Res Ed). 1982 Apr 10;284(6322):1078-81
6802412
Br Med J (Clin Res Ed). 1985 Nov 2;291(6504):1243-6
3933617
Pediatr Infect Dis J. 2000 Feb;19(2):95-104
10693993
Pediatr Infect Dis J. 1996 Sep;15(9 Suppl):S15-9
8878241
Lancet. 1997 Jul 19;350(9072):185-6
9250191
N Engl J Med. 1994 Apr 28;330(17):1229-30
8139634
Pediatr Infect Dis J. 1999 May;18(5):403-9
10353511
N Z Med J. 1990 Jan 24;103(882):25-6
2406651
Pediatr Infect Dis J. 1988 Jan;7(1):14-23
3277153
Biometrics. 2000 Jun;56(2):455-63
10877304
Clin Otolaryngol Allied Sci. 1981 Feb;6(1):5-13
6791864
Pediatr Infect Dis J. 2004 Sep;23(9):834-8
15361722
Antimicrob Agents Chemother. 2000 Jan;44(1):43-50
10602721
J Antimicrob Chemother. 2003 Sep;52(3):469-72
12888586
Pediatr Infect Dis J. 1996 Sep;15(9 Suppl):S20-3
8878242
Int J Pediatr Otorhinolaryngol. 2006 May;70(5):915-23
16293317
J Antimicrob Chemother. 1996 Mar;37(3):565-73
9182113
BMJ. 1997 May 24;314(7093):1526-9
9183201
Pediatr Infect Dis J. 1996 Sep;15(9 Suppl):S24-9
8878243
Pediatrics. 1991 Apr;87(4):466-74
2011422
Pediatr Infect Dis J. 2006 Oct;25(10):981-6
17006311
Emerg Themes Epidemiol. 2008 Sep 30;5:13
18826567
Clin Pediatr (Phila). 1993 Sep;32(9):528-34
8258205
JAMA. 1997 Nov 26;278(20):1640-2
9388072
BMJ. 1990 Mar 3;300(6724):582-6
2108756
Ann Intern Med. 1995 Dec 1;123(11):873-7
7486471
J Chemother. 1997 Feb;9(1):44-50
9106017
JAMA. 1964 Jan 11;187:85-9
14066742
Scand J Infect Dis Suppl. 1992;83:22-5
1336892
N Engl J Med. 1988 Jun 30;318(26):1728-33
3374545
Pediatrics. 1995 Jul;96(1 Pt 1):126-31
7596700
J Pediatr. 1991 Jul;119(1 Pt 1):117-22
1906097
J Antimicrob Chemother. 1993 Jun;31 Suppl E:73-9
8396100
Acta Otolaryngol. 1982 Sep-Oct;94(3-4):283-7
6816006
J Antimicrob Chemother. 2009 Jul;64(1):16-24
19454521
Pediatr Clin North Am. 1996 Dec;43(6):1165-81
8973506
JAMA. 1998 Jun 3;279(21):1736-42
9624028
BMJ. 1997 Sep 13;315(7109):629-34
9310563
J Antimicrob Chemother. 1993 Jun;31 Suppl E:81-8
8396101
Pediatrics. 1997 Jan;99(1):23-8
8989332
Saudi Med J. 1999 Jan;20(1):41-5
27605271
Curr Opin Pediatr. 2008 Feb;20(1):72-8
18197043
J Antimicrob Chemother. 1990 Sep;26 Suppl A:29-36
2228842
Postgrad Med J. 1979;55 Suppl 4:39-41
44907
Infez Med. 1998;6(2):93-95
12750572
Am J Dis Child. 1965 Apr;109:308-13
14261009
J Microbiol Immunol Infect. 2004 Feb;37(1):57-62
15060689
Science. 1992 Aug 21;257(5073):1050-5
1509255
J Pediatr. 1994 Mar;124(3):355-67
8120703
Laryngoscope. 1987 Jan;97(1):16-8
3796171
Acta Otolaryngol. 1983 Jul-Aug;96(1-2):99-104
6412508
J Antimicrob Chemother. 1993 Jun;31 Suppl E:65-71
8396099
Curr Ther Res Clin Exp. 2003;64:30-42
24944351
J Clin Epidemiol. 1995 Jan;48(1):159-63
7853041
Pediatrics. 1995 Oct;96(4 Pt 1):712-5
7567336
J R Coll Gen Pract. 1986 Aug;36(289):356-8
3735223
Am J Dis Child. 1967 Aug;114(2):123-30
4952777
Int J Pediatr Otorhinolaryngol. 2003 Jan;67(1):43-51
12560149
Lancet. 1981 Oct 24;2(8252):883-7
6117681
Pediatr Infect Dis J. 1993 Jan;12(1):62-9
8417428
Int J Pediatr Otorhinolaryngol. 2000 Sep 29;55(2):109-15
11006450
Arch Otolaryngol Head Neck Surg. 2008 Feb;134(2):128-32
18283152
Pediatrics. 1969 Dec;44(6):940-4
4391491
J Antimicrob Chemother. 1996 Jun;37 Suppl C:71-81
8818848
Otolaryngol Clin North Am. 1991 Aug;24(4):859-75
1870879
Pediatr Infect Dis J. 1999 Oct;18(10):854-9
10530579
Eur J Pediatr. 1997 Nov;156(11):858-63
9392401
Lancet. 2004 Feb 7;363(9407):465-73
14962529
Eur J Clin Microbiol Infect Dis. 1997 Apr;16(4):283-6
9177961
Paediatr Child Health. 2009 Sep;14(7):457-64
20808476
Antimicrob Agents Chemother. 2003 Oct;47(10):3179-86
14506028
BMJ. 1991 Sep 7;303(6802):558-62
1912887
J Pediatr. 1998 Nov;133(5):634-9
9821420
Pediatrics. 1993 Jan;91(1):23-30
8416502
Int J Antimicrob Agents. 1996 Apr;6(4):233-8
18611713
Pediatrics. 2004 May;113(5):1451-65
15121972
Pediatr Infect Dis J. 2005 Feb;24(2):153-61
15702045
Clin Pediatr (Phila). 1994 Nov;33(11):642-6
7859421
Pediatr Infect Dis J. 2000 May;19(5):458-63
10819344
BMJ. 1991 Dec 7;303(6815):1450-2
1773154
Cochrane Database Syst Rev. 2000;(2):CD001095
10796591