To the Editor.
—Although the review by Williams et al1 provides additional evidence for a significant short-term impact of antibiotics on otitis media with effusion (OME), caution is necessary when generalizing their results. The "brouhaha" alluded to in the article's subtitle refers to the value of a therapeutic course of antimicrobials for OME; however, the authors included four trials of prophylactic antimicrobials2-5 —once-daily administration of a subtherapeutic dose of medication—in their meta-analyses of short-term and long-term OME outcomes. This confounds meaningful interpretation of the results by underestimating the impact of therapeutic antibiotics on OME control.Another caution in generalizing the results concerns the OME meta-analysis of intermediate- to long-term outcomes. The hypothesis tested was whether a single course of therapeutic or prophylactic antibiotic conferred benefits lasting up to 11 months; OME relapse was untreated when it occurred in each of the individual studies. Of interest to clinicians, however,
Rosenfeld RM. Antibiotics for Otitis Media: A Clarification. JAMA. 1994;271(6):430. doi:10.1001/jama.1994.03510300030029