Antibiotic therapy for acute otitis media in children: preventing complications or overprescribing?

Pediatrics

Acute otitis media (AOM) in children is a common infection that often leads to the use of antibiotics to prevent serious infectious complications. Guidelines often recommend an ‘active surveillance’ approach, but fear of complications such as mastoiditis leads many clinicians to prescribe antibiotics routinely. However, the actual impact of antibiotics in preventing infectious complications of AOM remains open to debate. In this context, this study was initiated to clarify the impact of these treatments on the prevention of infectious complications.

Methodology and results

This study compared the use of antibiotics in children with AOM with careful observation and monitoring or placebo. The main outcome measures were serious infectious complications (mastoiditis, meningitis) and non-serious infectious complications (eardrum perforation, contralateral otitis media, recurrence of AOM).

Firstly, this research showed that the use of antibiotics significantly reduced the risk of acute mastoiditis, with a relative risk reduction of 52%. On the other hand, although antibiotics appeared to reduce certain non-serious side-effects such as tympanic perforation, they increased the risk of undesirable effects (diarrhoea, skin rashes), with a relative increase in risk of 49%. The researchers also found no clear evidence of a protective effect of antibiotics against serious infectious complications (intracranial complications).

A cautious approach to prescribing antibiotics

The results of this study indicate that antibiotics can reduce the risk of certain serious complications of AOM in children, such as mastoiditis. However, their use also entails an increased risk of adverse effects and antibiotic resistance. These observations underline the need not to systematically prescribe antibiotics, but to adopt a more targeted approach based on each child's individual risk profile. Further research into risk factors will enable antibiotic prescriptions to be optimised, so as to maximise the benefits while minimising the risks.

Source(s) :
Smolinski, N. E., et al (2024). Antibiotic treatment to prevent pediatric acute otitis media infectious complications : A meta-analysis. PloS one, 19(6), e0304742. ;

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