The Journal of the American Medical Association has featured a systematic review on the diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media (AOM) in children. The systematic review also investigated the association between the use of heptavalent pneumococcal conjugate vaccine (PCV7) use with AOM microbiology.

The systematic review included data from 135 citations which met inclusion criteria. With respect to the treatment of AOM, the following results were reported:

• In the few available studies, prevalence of Streptococcus pneumoniae decreased (eg, 33%-48% vs 23%-31% of AOM isolates), while that of Haemophilus influenzae increased (41%-43% vs 56%-57%) pre- vs post-PCV7.
• Short-term clinical success was higher for immediate use of ampicillin or amoxicillin vs placebo (73% vs 60%; pooled rate difference, 12% [95% CI, 5%-18%]; number needed to treat, 9 [6-20]), while increasing the rate of rash or diarrhoea by 3% to 5%.
• Two of 4 studies showed greater clinical success for immediate vs delayed antibiotics (95% vs 80%; rate difference, 15% [6%-24%] and 86% vs 70%; rate difference, 16% [6%-26%]), NNT, 6 [4 to 17]), also favouring amoxicillin over the prescription- to-hold approach for parent perceived clinical success at day 3.
• The meta-analyses in general showed no significant differences in antibiotic comparative effectiveness.
• Pooled analysis of 3 trials yielded rates of 13% vs 8% for diarrhoea (pooled rate difference, 5% [0% to 10%]; P=0.30), while 2 individual studies had a rate difference of 4% (4% vs 0%) and 3% (8% vs 5%) for rash although these differences did not reach statistical significance.

The researchers concluded that antibiotics are modestly more effective than no treatment but cause adverse effects in 4% to 10% of children.