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July 28, 1993

Antimicrobial Therapy for Otitis Media With Effusion: The Pittsburgh Response

JAMA. 1993;270(4):449-450. doi:10.1001/jama.1993.03510040053016

To the Editor.  —On reading a recent Commentary by Mandel et al,1I was struck by the absence of any reference to the only published meta-analysis2 addressing the efficacy of antimicrobials for otitis media with effusion (OME) in children. In their overview of 1325 children from 10 randomized clinical trials, Rosenfeld and Post2 found a 22.8% treatment advantage (95% CI, 10.5% to 35.1%) for antimicrobials over placebo or no drug. What effect—if any—does "The Cantekin Affair"3 have on the interpretation and validity of this finding?The Cantekin affair concerns one of the 10 studies in the meta-analysis, and relates primarily to the choice of OME outcome measure: algorithm vs tympanometry. Mandel et al4 initially reported a 14.6% treatment advantage for amoxicillin (95% CI, 5.8% to 23.5%; P=.002) based on an otoscopic-tympanometric algorithm; this outcome measure was therefore used in the meta-analysis. A dissenting version