Evidence To Change Practice
We have changed our practice policy for treating Acute Otitis Media in response to a Cochrane Review of the risks and benefits of using antibiotics in this condition. The figures in the handout are taken from the original review in 1998 and are still correct for children over 2 years of age. For children under 2 a new trial suggests that the resolution of pain is slower and the Number Needed to treat is around 9 in this age group. A summary of the updated NNTs from the Cochrane review was the subject of one of the newsletters from this site and can be seen here.
In 2006 an Individual Patient Data Meta-analysis was published in the Lancet this gave an indication of which children with otitis media gained the most benefit from antibiotics (Rovers MM, Glasziou P, Appelman CL, et al. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet 2006; 368: 1429-1435.) Those who are under 2 years of age with bilateral ear infections, children of any age with a discharging ear fall into this category. This was covered in the December 2006 Newsletter. There is also data to suggest that children who are systemically unwell (such as with high fever or vomiting) benefit more from antibiotics (Little P, Gould C, Moore M, Warner G, Dunleavey J, Williamson I, et al. Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial. BMJ 2002;325(7354):22-8).
Details of our approach and the impact on our antibiotic prescribing for children have been published in the BMJ . A handout for Antibiotics and Ear Infections to give out to parents of children with Acute Otitis Media is accessible on this site by using the link. Please feel free to modify the handout for your own use, but you may wish to bear in mind that we still tend to give antibiotics to children who are systemically unwell (such as having a high fever).
If you do try out the handout I would be interested to know (in due course) how you get on. Let me know chris.cates@nhs.net
Link to the 2004 update of the Cochrane Review (which is freely available to users with an ISP address in the UK and some other countries)