Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
To the Editor: In his Clinical Crossroads article
about a 15-month-old child with recurrent otitis media, Dr Paradise1 concluded that it would be "injudicious" to withhold
antibiotics from patients with acute otitis media (AOM). However, he did not
consider important evidence necessary to place the discussion in its proper
Although antibiotics appear to have some beneficial effect in the treatment
of AOM, the magnitude of benefit appears small. A recent review of studies
designed to address this question found no reduction in pain at 24 hours and
only a 5% absolute reduction in the number of patients with pain after 2 to
7 days.2 This means that approximately 17
children must be treated with antibiotics to prevent 1 child from having pain
during the same period. One of the studies cited by Paradise noted about a
13% absolute reduction in symptoms at day 4 in children younger than 2 years,3 but even this minimal benefit would require 7 to
8 children with AOM to receive antibiotics to prevent 1 child from having
symptoms at the fourth day.
Jackson AB, Kadota R, Gordon J. Recurrent Otitis Media in Children. JAMA. 2003;289(11):1382-1385. doi:10.1001/jama.289.11.1382-a