Antibiotics are “not very useful” for the majority of children with middle-ear infection, the authors of a Cochrane review have concluded.
Researchers from Holland and Australia noted that antibiotic prescribing for acute otitis media (AOM) varied from 56% in the Netherlands to 95% in the US, Canada and Australia.
They carried out a systematic review to assess the effectiveness of antibiotics compared to placebo in children with AOM. It included 12 trials with 3,317 children and 3,854 AOM episodes.
They found antibiotics did not decrease the number of children with pain at 24 hours, only slightly reduced the number of children with pain in the few days following and did not reduce the number of children with short-term hearing loss.
About 20 children needed to be treated to prevent one suffering from ear pain at two to seven days, they said.
However, antibiotic treatment did reduce the number of tympanic membrane perforations and contralateral AOM episodes.
The authors said: “Antibiotics seem to be most beneficial in children younger than two years of age with infection in both ears and in children with both AOM and discharge from the ear.”
But they added: “Antibiotics caused unwanted effects such as diarrhoea, vomiting and rash and may also increase resistance to antibiotics in the community… For most children with mild disease, an expectant observational approach seems justified.”