Antibiotic treatment to prevent pediatric acute otitis media infectious complications: A meta-analysis

• Published in: PloS one 2024-06, Vol.19 (6), p.e0304742
• Main Authors: Smolinski, Nicole E, Djabali, Emma J, Al-Bahou, Julie, Pomputius, Ariel, Antonelli, Patrick J, Winterstein, Almut G
• Format: Article
• Language: English
• Subjects: Acute Disease; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bias; Biology and Life Sciences; Child; Child, Preschool; Clinical trials; Complications and side effects; Drug therapy; Ear diseases; Humans; Mastoiditis; Mastoiditis - drug therapy; Mastoiditis - prevention & control; Medical research; Medicine and Health Sciences; Medicine, Experimental; Meta-analysis; Observational studies; Otitis media; Otitis Media - drug therapy; Pediatrics; Population studies; Prevention; Public health; Randomized Controlled Trials as Topic; Research and Analysis Methods; Risk factors; Risk reduction; Sensitivity analysis
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0304742

Most US children with acute otitis media [AOM] receive prompt antibiotic treatment, though guidelines encourage watchful waiting. Previous systematic reviews of antibiotics versus watchful waiting have focused on symptom resolution and RCTs, limiting the assessment of serious, rare complications. We sought to evaluate these complications by including observational studies. RCTs and observational studies that compared antibiotics to placebo or watchful waiting for pediatric clinician diagnosed AOM were identified [PubMed/MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, and Web of Science] and reviewed for meta-analysis. Two reviewers independently extracted study characteristics, patient characteristics, and outcomes. We assessed publication bias, study bias with ROBINS-1 and RoB-2 and used random-effects models to assess treatment effects. 24 studies were included. Antibiotics decreased the risk of acute mastoiditis [incidence 0.02%, RR 0.48, 95% CI 0.40-0.59; NNT 5,368]. This protective effect may be underestimated because of misclassification of non-suppurative conditions as AOM. Intracranial complications remained too rare to assess. Antibiotics markedly increased the risk of adverse effects [incidence 10.5%, RR 1.49, 1.27-1.73; NNH 23]. Studies used non-specific criteria for acute mastoiditis, potentially underestimating treatment effects. Prompt antibiotic therapy reduces the risk for some AOM complications. The NNT to prevent serious, rare complications is high, while the NNH is relatively low. Large-scale population-based observational studies using real-world datasets with validated measures of severe complications are needed to improve understanding of risk factors for serious AOM complications, facilitate more selective antibiotic therapy, and optimize individual outcomes and public health.