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February 9, 1994

Antibiotics for Otitis Media: A Clarification-Reply

Author Affiliations

Case Western Reserve University School of Medicine Cleveland, Ohio
Harvard School of Public Health Boston, Mass
Skagit Pediatrics Mt Vernon, Wash

JAMA. 1994;271(6):430. doi:10.1001/jama.1994.03510300030030

In Reply.  —Dr Rosenfeld is concerned with that portion of our article that covers OME. He suggests that four studies1-4 used subtherapeutic antibiotic dosages and should therefore be excluded from the analyses. In fact, two of these studies1,2 used dosages that fall in the range of recommended therapy. More importantly, however, a close reading of our article will show that his concern has already been addressed. Three of the studies2-4 he questioned used antibiotics that are not generally considered to be effective in treatment of otitis media. In our meta-analyses, we performed subgroup analyses that separated the studies by whether they used antibiotics active against middle-ear pathogens. In these subgroup analyses, eliminating those studies using antibiotics of uncertain efficacy (including three of those questioned by Rosenfeld) produced no change in the results, as shown in Figs 2, 3, and 4 of the article. The fourth study1

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