Children with fever and vomiting benefit from immediate antibiotics for acute otitis media

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Children with fever and vomiting benefit from immediate antibiotics for acute otitis media

J Fam Pract. 2003 January;52(1):12-31

By

Mary Beth Weick, MD

Kevin Y. Kane, MD, MSPH

BACKGROUND: Which children will benefit from immediate treatment for otitis media? Acute otitis media is one of the most common childhood infections, yet there is much debate about its management. This study sought to determine symptoms that would predict which children would be at risk of prolonged symptoms and whether they would benefit from immediate antibiotic treatment.
POPULATION STUDIED: This study included 315 children aged 6 months to 10 years taken to their general practitioner with acute otalgia and found to have otoscopic evidence of acute inflammation (dullness, erythema or bulging, cloudiness, or perforation). Otoscopic evidence alone was used if the child was too young to reliably complain of otalgia. There was a 90% follow-up rate.
STUDY DESIGN AND VALIDITY: This investigation was a secondary analysis of a previous randomized controlled trial¹ designed to investigate antibiotic prescribing strategies for acute otitis media. Patients were randomized based on sealed numbered envelopes (allocation concealed) into two groups. The first group started antibiotics immediately (amoxicillin, or erythromycin if the child was allergic to penicillin). In the second group, parents were given a prescription but were asked to wait 72 hours, to see if severe otalgia or fever remained, before starting the antibiotics. Parents in the delayed group were also instructed to start the antibiotics if ear discharge was still present after 10 days. This follow-up study used logistic regression to determine which symptoms, if present on day 1, were predictive of worse outcomes. Neither patients nor physicians were blinded. This non-blinded design creates a potential for bias in the way parents perceive and record symptoms. This reporting bias could affect the results in a way that favors antibiotic treatment when no difference actually exists.
OUTCOMES MEASURED: Primary outcomes were an episode of distress or night disturbance 3 days after a physician saw the patient. Physicians recorded days of illness, physical signs, and whether an antibiotic was prescribed. Parents recorded symptoms, perceived pain, number of episodes of distress, doses of acetaminophen given, and temperature.
RESULTS: Symptoms still present after 3 days were more likely in children initially presenting with temperatures greater than 37.5°C (adjusted odds ratio [OR]=4.5, 95% confidence interval [CI] 2.3–9.0), vomiting (OR=2.6, 95% CI 1.3– 5.0), or cough (OR=2.0, 95% CI 1.1–3.8).

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Children with fever and vomiting benefit from immediate antibiotics for acute otitis media

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