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July 20, 1994

Antibiotics to Prevent Acute Otitis Media and to Treat Otitis Media With Effusion

Author Affiliations

University of Pittsburgh Pittsburgh, Pa

JAMA. 1994;272(3):203-204. doi:10.1001/jama.1994.03520030043025

To the Editor.  —In the abstract of their article, Dr Williams and colleagues1 report that "studies of antibiotic prophylaxis of recurrent otitis media... had an RD [rate difference] of 0.11 (95% confidence interval [CI], 0.03 to 0.19) favoring antibiotic treatment" and "studies of short-term patient outcomes of OME [otitis media with effusion]... had an RD favoring antibiotics of 0.16 (95% CI, 0.03 to 0.29)." They then conclude, "Antibiotics appear to have beneficial but limited effect on recurrent otitis media and short-term resolution of OME." Given that many journal readers read only the abstracts, the above is positively misleading.The prophylaxis trials have significant heterogeneity (RDs, 0.011 to 0.366; q=17.5; P<.03), a fact not mentioned by the authors. The RD of 0.11 of Williams et al is calculated by combining studies using different drugs with significantly different effects. The RD for sulfisoxazole (0.20) is significantly higher than the

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