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March 19, 2003

Recurrent Otitis Media in Children

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(11):1382-1385. doi:10.1001/jama.289.11.1382-a

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 context.

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.