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

Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial
Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial
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.
0959-8138
22-24
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Gould, Clare
058d7307-9b42-4f85-b02e-7e3a37d9af67
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Warner, Greg
72005519-1aa0-42da-b370-7ebd99792539
Dunleavey, Joan
48a52b61-973f-4efc-a2ac-ad4bb7c00ceb
Williamson, Ian
12381296-edbf-4ac5-969b-dcb559c22f27
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Gould, Clare
058d7307-9b42-4f85-b02e-7e3a37d9af67
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Warner, Greg
72005519-1aa0-42da-b370-7ebd99792539
Dunleavey, Joan
48a52b61-973f-4efc-a2ac-ad4bb7c00ceb
Williamson, Ian
12381296-edbf-4ac5-969b-dcb559c22f27

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. BMJ, 325 (7354), 22-24. (doi:10.1136/bmj.325.7354.22).

Record type: Article

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, 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.

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More information

Published date: 2002
Additional Information: Primary Care

Identifiers

Local EPrints ID: 24401
URI: http://eprints.soton.ac.uk/id/eprint/24401
ISSN: 0959-8138
PURE UUID: 09658fee-0a32-4dbf-8605-06f74723c83e
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 30 Mar 2006
Last modified: 09 Jan 2022 03:17

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Contributors

Author: Paul Little
Author: Clare Gould
Author: Michael Moore ORCID iD
Author: Greg Warner
Author: Joan Dunleavey
Author: Ian Williamson

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