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March 9, 2011

Antibiotics and Acute Otitis Media in Children

JAMA. 2011;305(10):997-998. doi:10.1001/jama.2011.240

To the Editor: The overall conclusion of the review by Dr Coker and colleagues1 that “Clinicians need to weigh these risks . . . and benefits before prescribing immediate antibiotics for uncomplicated AOM [acute otitis media]” is broadly correct. However, the benefits may be different for different groups of children. A previous systematic review2 based on patient-level data from individual trials found that prognosis was worse, and treatment effects greater, in children younger than 2 years with bilateral acute otitis media. The conclusion in that review and in a Cochrane review3 was based on the patient-oriented outcomes of pain, fever, and hearing. These outcomes seem more relevant than the clinician-oriented outcome of “clinical cure.” The difference in outcomes, and the exclusion of 1 trial4 because it “did not report clinical success (only pain resolution),” might explain the more favorable number needed to treat of 9 calculated in the Coker et al review compared with 15 in the Cochrane Review.3