Question

• An otherwise healthy child has multiple episodes of otitis media. Will prophylactic antibiotics help prevent further episodes?

Clinical Bottom Lines

1. Prophylactic antibiotics do indeed prevent recurrence of otitis media.
2. This meta-analysis¹ of nine studies, including a total of 958 patients concluded that the number of children needed to treat (NNT) with prophylactic antibiotics to prevent an episode of recurrent otitis media was nine.

Summary of Key Evidence

1. Only randomized, controlled trials were used, taken from several different sources (MEDLINE from 1966 through April 1993, textbooks, Current Contents, and bibliographies of selected articles), and the validity of each trial was reviewed by two separate people using standardized forms.
2. The results were consistent from study to study--all nine studies showed a trend toward benefit, and two were statistically significant.

Additional Comments

• The quality rating of some of the studies was poor, but there was no correlation between quality of study and outcome.
• Further study is needed to determine:
• Characteristics of patients most likely to benefit from this therapy.
• Specific antibiotic recommendations.
• Duration of treatment.

Citation

1. Williams, et al.  Use of antibiotics in preventing recurrent acute otitis media and in treating otitis media with effusion. A meta-analytic attempt to resolve the brouhaha.  JAMA.  1993; 270:1344-1351.

CAT Author: Andrew Seiler, MD

CAT Appraisers:

Date appraised: September 7, 1998