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Primary carePredictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trialCommentary: research directions for treatment for acute otitis media

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7354.22 (Published 06 July 2002) Cite this as: BMJ 2002;325:22

Footnotes

Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial

  1. Paul Little, clinician scientist (psl3{at}soton.ac.uk)a,
  2. Clare Gould, research assistanta,
  3. Michael Moore, general practitionerb,
  4. Greg Warner, general practitionerc,
  5. Joan Dunleavey, research coordinatora,
  6. Ian Williamson, senior lecturera
  1. aCommunity Clinical Sciences (Primary Medical Care Group), University of Southampton, Aldermoor Health Centre, Southampton SO15 6ST
  2. bThree Swans Surgery, Salisbury, Wiltshire SP1 1DX
  3. cNightingale Surgery, Romsey, Hampshire SO51 7QN
  4. Centre for General Practice, University of Queensland Medical School, Herston, Queensland 4006, Australia
  1. Correspondence to: P Little

    abstract

    Objectives: To identify which children with acute otitis media are at risk of poor outcome and to assess benefit from antibiotics in these children.

    Design: Secondary analysis of randomised controlled trial cohort.

    Setting: Primary care.

    Participants: 315 children aged 6 months to 10 years.

    Intervention: Immediate or delayed (taken after 72 hours if necessary) antibiotics.

    Main outcome measure: Predictors of short term outcome: an episode of distress or night disturbance three days after child saw doctor.

    Results: Distress by day three was more likely in children with high temperature (adjusted odds ratio 4.5, 95% confidence interval 2.3 to 9.0), vomiting (2.6,1.3 to 5.0), and cough (2.0, 1.1 to 3.8) on day one. Night disturbance by day three was more likely with high temperature 2.4 (1.2 to 4.8), vomiting (2.1,1.1 to 4.0), cough (2.3,1.3 to 4.2), and ear discharge (2.1, 1.2 to 3.9). Among the children with high temperature or vomiting, distress by day three was less likely with immediate antibiotics (32% for immediate v 53% for delayed, χ2=4.0; P=0.045, number needed to treat 5) as was night disturbance (26% v 59%, χ2=9.3; P=0.002; number needed to treat 3). In children without higher temperature or vomiting, immediate antibiotics made little difference to distress by day three (15% v 19%, χ2=0.74; P=0.39) or night disturbance (20% v 27%, χ2=1.6; P=0.20). Addition of cough did not significantly improve prediction of benefit.

    Conclusion: In children with otitis media but without fever and vomiting antibiotic treatment has little benefit and a poor outcome is unlikely.

    Footnotes

    • Funding PL is supported by the MRC.

    • Competing interests PL has received fees from Abbott Pharmaceuticals for two consultancy meetings.

    Commentary: research directions for treatment for acute otitis media

    1. Chris Del Mar, professor of general practice (C.Delmar{at}CGP.uq.edu.au),
    2. Jenny Doust, senior research fellow
    1. aCommunity Clinical Sciences (Primary Medical Care Group), University of Southampton, Aldermoor Health Centre, Southampton SO15 6ST
    2. bThree Swans Surgery, Salisbury, Wiltshire SP1 1DX
    3. cNightingale Surgery, Romsey, Hampshire SO51 7QN
    4. Centre for General Practice, University of Queensland Medical School, Herston, Queensland 4006, Australia
    1. Correspondence to: Chris Del Mar
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