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

Little, Paul, Gould, Clare, Moore, Michael, Warner, Greg, Dunleavey, Joan and Williamson, Ian (2002) Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial. British Medical Journal, 325, (7354), 22-24. (doi:10.1136/bmj.325.7354.22).


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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, 2=4.0; P=0.045, number needed to treat 5) as was night disturbance (26% v 59%, 2=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%, 2=0.74; P=0.39) or night disturbance (20% v 27%, 2=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.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1136/bmj.325.7354.22
Additional Information: Primary Care
ISSNs: 0959-8138 (print)
Related URLs:
Subjects: R Medicine > RF Otorhinolaryngology
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Divisions : University Structure - Pre August 2011 > School of Medicine > Community Clinical Sciences
ePrint ID: 24401
Accepted Date and Publication Date:
Date Deposited: 30 Mar 2006
Last Modified: 31 Mar 2016 11:45

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