Document Detail


Efficacy of short course (<4 days) of antibiotics for treatment of acute otitis media in children: a systematic review of randomized controlled trials.
MedLine Citation:
PMID:  19736367     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the efficacy of a short course of antibiotics (<4 days) in comparison to a longer course (>4 days) for the treatment of acute otitis media in children. DATA SOURCES: Electronic databases, hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences. REVIEW METHODS: Randomized controlled trials of the empiric treatment of acute otitis media comparing antibiotic regimens of <4 days versus > 4 days in children between four weeks to eighteen years of age were included. The trials were grouped by pharmacokinetic behavior of short-course antibiotics into short-acting antibiotics, parenteral ceftriaxone, and long-acting azithromycin. RESULTS: We reviewed 35 trials, which provided 38 analytic components. Overall, there was no evidence of an increased risk of treatment failure until one month with a short-course of antibiotics (RR=1.06, 95% CI 0.95 to 1.17, P=0.298). Use of short-acting oral antibiotic in short-course was associated with a significantly increased risk of treatment failure (RR=2.27, 95% CI: 1.04 to 4.99). There was a slightly increased risk of treatment failure with parenteral ceftriaxone (RR=1.13, 95% CI 0.99 to 1.30). The risk of adverse effects was significantly lower with short-course regimens (RR=0.58, 95% CI: 0.48 to 0.70). CONCLUSION: There is no evidence of an increased risk of treatment failure with short course of antibiotics for acute otitis media. Among the short course regimens, azithromycin use was associated with a lower risk of treatment failure while short acting oral antibiotics and parenteral ceftriaxone may be associated with a higher risk of treatment failure.
Authors:
Anjana Gulani; H P S Sachdev; Shamim A Qazi
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2009-09-03
Journal Detail:
Title:  Indian pediatrics     Volume:  47     ISSN:  0974-7559     ISO Abbreviation:  Indian Pediatr     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-08     Completed Date:  2010-05-10     Revised Date:  2010-11-15    
Medline Journal Info:
Nlm Unique ID:  2985062R     Medline TA:  Indian Pediatr     Country:  India    
Other Details:
Languages:  eng     Pagination:  74-87     Citation Subset:  IM    
Affiliation:
Department of Pediatrics and Clinical Epidemology, Sitaram Bhartia Institute of Science and Research, Qutab Institutional Area, New Delhi 110 016, India.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Anti-Bacterial Agents / administration & dosage*
Azithromycin / administration & dosage
Ceftriaxone / administration & dosage
Child
Child, Preschool
Drug Administration Schedule
Humans
Infant
Otitis Media / drug therapy*
Randomized Controlled Trials as Topic
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 73384-59-5/Ceftriaxone; 83905-01-5/Azithromycin

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