In Reply: Most of the studies cited by Dr Jackson
and colleagues and by Drs Mascitelli and Pezzetta as indicating limited effectiveness
of antibiotic treatment for AOM had one or more major limitations, each of
which would militate against showing differences between treatment regimens.
The limitations include limited sample size and statistical power, exclusion
of children who seemed ill, enrollment of few or no children younger than
2 years, lack of standardized or stringent criteria for diagnosing AOM or
for defining improvement or cure, use of an antimicrobial with less than optimal
efficacy against common middle ear pathogens, and use of lower than optimal
Paradise JL. Recurrent Otitis Media in Children—Reply. JAMA. 2003;289(11):1382–1385. doi:10.1001/jama.289.11.1382-a
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