Antibiotics more beneficial in bilateral otitis media
Antibiotics are beneficial for relieving pain and fever in children aged under two years with acute otitis media in both ears or for children of any age with acute otitis media and otorrhoea (discharge from the ear), the authors of a study published in The
Lancet conclude (2006;368:1429).
For most other children with mild disease a watch and wait policy seems
justified, they say.
The meta-analysis combined data from six trials involving 1,643 children
aged six months to 12 years. The primary outcome was persistence of otitis
media with pain or fever, or both, at three to seven days.
In children under two years old with bilateral otitis media, four would
need to be treated to prevent an extended course of the disease in one
child. In children older than two years with bilateral infection the
number needed to treat would be nine. In children with unilateral infection
the numbers needed to treat would be 20 and 15, respectively. The researchers
also found that children with otorrhoea were more likely to benefit from
antibiotics.
The researchers postulate that in children younger than two years with
bilateral otitis media and in those with otorrhoea, the infection is
more often bacterial than viral.
Antihistamines
and decongestants Antihistamines
and decongestants should not be used either alone or in combination
to treat acute otitis media
with discharge
in children, according to a recent Cochrane
review.
The reviewers analysed 15 trials involving 1,516 children and found no statistical
or clinical benefit for any of the interventions or outcomes studied. In addition,
in the six studies that examined side effects, treated subjects experienced
11 per cent more side effects than untreated subjects. This means that
for every
nine children treated, one will be harmed and none will benefit. |
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