Decongestants and antihistamines for acute otitis media in children

Background Acute otitis media ( AOM) is a common and important source of morbidity in children, although the majority of cases resolve spontaneously. While frequently recommended, decongestant and antihistamine therapy is of unclear benefit. Objectives To determine the efficacy of decongestant and antihistamine therapy in children with AOM on outcomes of AOM resolution, symptom resolution, medication side effects, and complications of AOM. Search strategy In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2); MEDLINE ( January 2004 to May 2007); and EMBASE ( July 2003 to May 2007). Selection criteria Randomized controlled trials ( RCTs) evaluating decongestant or antihistamine treatment for children with AOM were included. Patient-oriented outcomes were considered most relevant. Data collection and analysis The review authors independently evaluated studies for inclusion, performed validity assessments and completed data extraction. Dichotomous data were pooled to generate relative risks; homogeneity was assessed using approximate chi-square tests. Main results No new studies were included following this updated search. Fifteen trials involving 2695 people were included. Only the combined decongestant-antihistamine group demonstrated statistically lower rates of persistent AOM at the two week period ( fixed relative risk ( RR) 0.76; 95% confidence interval ( CI) 0.60 to 0.96; number needed to treat ( NNT) 10). No benefit was found for early cure rates, symptom resolution, prevention of surgery or other complications. There was a five to eight-fold increased risk of side effects for those receiving an intervention, which reached statistical significance for all decongestant groupings. Validity sub analyses demonstrated that lower quality studies found benefit, while analysis of those studies with higher validity scores found no benefit of treatment
ISSN/ISBN: 1469-493X
WEB/URL: ISI:000257810900104;

allergic rhinitis, review, otitis media, assessment, treatment, randomized controlled trial, prevention, morbidity, england, corticosteroid treatment, medline, controlled-trial, complications, therapies, eustachian-tube function, people, medication, primary care, analysis, surgery, children, therapy, effusion, quality, pediatric practice, efficacy, primary-care, randomized trial, intervention, oral decongestant, outcome, middle-ear fluid, rates, care, validity, outcomes, trials, risk, randomized controlled trials, data collection, double-blind, controlled trial, time, trial, clinical-trial, strategies

10.1002/14651858.CD001727.pub4

1469-493X

Coleman, Cassie

e02525a2-c833-4396-af1b-ef40a475e99b

Moore, Michael

1be81dad-7120-45f0-bbed-f3b0cc0cfe99

2008

Coleman, Cassie

e02525a2-c833-4396-af1b-ef40a475e99b

Moore, Michael

1be81dad-7120-45f0-bbed-f3b0cc0cfe99

Coleman, Cassie and Moore, Michael (2008) Decongestants and antihistamines for acute otitis media in children. Cochrane Database of Systematic Reviews, 3 (CD001727). (doi:10.1002/14651858.CD001727.pub4).

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Published date: 2008

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http://www.cochrane.org/review...01727.html

Keywords: allergic rhinitis, review, otitis media, assessment, treatment, randomized controlled trial, prevention, morbidity, england, corticosteroid treatment, medline, controlled-trial, complications, therapies, eustachian-tube function, people, medication, primary care, analysis, surgery, children, therapy, effusion, quality, pediatric practice, efficacy, primary-care, randomized trial, intervention, oral decongestant, outcome, middle-ear fluid, rates, care, validity, outcomes, trials, risk, randomized controlled trials, data collection, double-blind, controlled trial, time, trial, clinical-trial, strategies