Treatment of acute otitis media with a shortened course of antibiotics: a meta-analysis. Export

@article{citeulike:3519126, abstract = {OBJECTIVE: To conduct a meta-analysis of randomized controlled trials of antibiotic treatment of acute otitis media in children to determine whether outcomes were comparable in children treated with antibiotics for less than 7 days or at least 7 days or more. DATA SOURCES: MEDLINE (1966-1997), EMBASE (1974-1997), Current Contents, and Science Citation Index searches were conducted to identify randomized controlled trials of the treatment of acute otitis media in children with antibiotics of different durations. STUDY SELECTION: Studies were included if they met the following criteria: subjects aged 4 weeks to 18 years, clinical diagnosis of acute otitis media, no antimicrobial therapy at time of diagnosis, and randomization to less than 7 days of antibiotic treatment vs 7 days or more of antibiotic treatment. DATA EXTRACTION: Trial methodological quality was assessed independently by 7 reviewers; outcomes were extracted as the number of treatment failures, relapses, or reinfections. DATA SYNTHESIS: Included trials were grouped by antibiotic used in the short course: (1) 15 short-acting oral antibiotic trials (penicillin V potassium, amoxicillin [-clavulanate], cefaclor, cefixime, cefuroxime, cefpodoxime proxetil, cefprozil), (2) 4 intramuscularceftriaxone sodium trials, and (3) 11 oral azithromycin trials. The summary odds ratio for treatment outcomes at 8 to 19 days in children treated with short-acting antibiotics for 5 days vs 8 to 10 days was 1.52 (95\% confidence interval [CI], 1.17-1.98) but by 20 to 30 days outcomes between treatment groups were comparable (odds ratio, 1.22; 95\% CI, 0.98 to 1.54). The risk difference (2.3\%; 95\% CI,-0.2\% to 4.9\%) at 20 to 30 days suggests that 44 children would need to be treated with the long course of short-acting antibiotics to avoid 1 treatment failure. This similarity in later outcomes was observed for up to 3 months following therapy (odds ratio, 1.16; 95\% CI, 0.90-1.50). Comparable outcomes were shown between treatment with ceftriaxone or azithromycin, and at least 7 days of other antibiotics. CONCLUSION: This meta-analysis suggests that 5 days of short-acting antibiotic use is effective treatment for uncomplicated acute otitis media in children.}, author = {Kozyrskyj, A. L. and Hildes-Ripstein, G. E. and Longstaffe, S. E. and Wincott, J. L. and Sitar, D. S. and Klassen, T. P. and Moffatt, M. E.}, citeulike-article-id = {3519126}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/9624028}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=9624028}, day = {3}, issn = {0098-7484}, journal = {JAMA : the journal of the American Medical Association}, keywords = {aom}, month = {June}, number = {21}, pages = {1736--1742}, posted-at = {2009-03-25 01:47:53}, priority = {2}, title = {Treatment of acute otitis media with a shortened course of antibiotics: a meta-analysis.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/9624028}, volume = {279}, year = {1998} }

TY - JOUR ID - citeulike:3519126 L3 - citeulike-article-id:3519126 N2 - OBJECTIVE: To conduct a meta-analysis of randomized controlled trials of antibiotic treatment of acute otitis media in children to determine whether outcomes were comparable in children treated with antibiotics for less than 7 days or at least 7 days or more. DATA SOURCES: MEDLINE (1966-1997), EMBASE (1974-1997), Current Contents, and Science Citation Index searches were conducted to identify randomized controlled trials of the treatment of acute otitis media in children with antibiotics of different durations. STUDY SELECTION: Studies were included if they met the following criteria: subjects aged 4 weeks to 18 years, clinical diagnosis of acute otitis media, no antimicrobial therapy at time of diagnosis, and randomization to less than 7 days of antibiotic treatment vs 7 days or more of antibiotic treatment. DATA EXTRACTION: Trial methodological quality was assessed independently by 7 reviewers; outcomes were extracted as the number of treatment failures, relapses, or reinfections. DATA SYNTHESIS: Included trials were grouped by antibiotic used in the short course: (1) 15 short-acting oral antibiotic trials (penicillin V potassium, amoxicillin [-clavulanate], cefaclor, cefixime, cefuroxime, cefpodoxime proxetil, cefprozil), (2) 4 intramuscularceftriaxone sodium trials, and (3) 11 oral azithromycin trials. The summary odds ratio for treatment outcomes at 8 to 19 days in children treated with short-acting antibiotics for 5 days vs 8 to 10 days was 1.52 (95% confidence interval [CI], 1.17-1.98) but by 20 to 30 days outcomes between treatment groups were comparable (odds ratio, 1.22; 95% CI, 0.98 to 1.54). The risk difference (2.3%; 95% CI,-0.2% to 4.9%) at 20 to 30 days suggests that 44 children would need to be treated with the long course of short-acting antibiotics to avoid 1 treatment failure. This similarity in later outcomes was observed for up to 3 months following therapy (odds ratio, 1.16; 95% CI, 0.90-1.50). Comparable outcomes were shown between treatment with ceftriaxone or azithromycin, and at least 7 days of other antibiotics. CONCLUSION: This meta-analysis suggests that 5 days of short-acting antibiotic use is effective treatment for uncomplicated acute otitis media in children. IS - 21 JF - JAMA : the journal of the American Medical Association SN - 0098-7484 EP - 1742 TI - Treatment of acute otitis media with a shortened course of antibiotics: a meta-analysis. VL - 279 SP - 1736 KW - aom AU - Kozyrskyj, AL AU - Hildes-Ripstein, GE AU - Longstaffe, SE AU - Wincott, JL AU - Sitar, DS AU - Klassen, TP AU - Moffatt, ME PY - 1998/06/03/ UR - http://view.ncbi.nlm.nih.gov/pubmed/9624028 ER -