The Pharmaceutical Journal
Vol 269 No 7206 p48
13 July 2002

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BMJ (bmj.com)

Keep antibiotics for otitis media seen with fever and vomiting

Antibiotics are only likely to benefit children with otitis media if they have fever or present with vomiting, an analysis of data from a new trial has shown.

The study set out to examine which children with acute otitis media were at risk of a poor outcome, and whether or not these children might benefit from immediate antibiotics. In all, 315 children aged six months to 10 years with acute otitis media were randomised to receive antibiotic treatment immediately or 72 hours later.

The parents of all children in the trial used diaries to record the children's symptoms — severity of pain, episodes of distress, number of paracetamol doses used and temperature. Parents also noted the presence of cough, vomiting, rash and diarrhoea.

Children who had high temperatures or were vomiting were more likely to have a poor outcome by day three. "These children represent the simplest way to target antibiotics for clinicians and are a small minority," write the researchers.

Of the children who had high temperature or vomiting, distress by day three was less likely among those given immediate antibiotics compared with those whose antibiotics were delayed (32 vs 53 per cent) (BMJ 2002;325:22).