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Systematic review and meta-analysis
Oral antibiotics confer small benefits and small harms in low-risk children with acute otitis media
  1. Hasantha Gunasekera
  1. Department of General Medicine, The Children's Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to : Dr Hasantha Gunasekera
    , Department of General Medicine, The Children's Hospital at Westmead, Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia; hasantha.gunasekera{at}

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Acute otitis media (AOM) affects most children by the time they reach school age and is a common reason for presentation to healthcare professionals globally. Pathogenic bacteria are isolated from middle ear fluid in AOM and so antibiotics are frequently considered necessary. However, unlike other bacterial infections, the vast majority of children with AOM recover within a week without antibiotics. Antibiotics also have known harms and antibiotic resistance is increasing worldwide. Therefore, ‘watchful waiting’ or ‘expectant observation’ is either recommended or considered reasonable in guidelines for the management of uncomplicated AOM in children aged over 2 years in Australia,1 Canada,2 France,2 Germany,2 Scotland,2 Spain,2 the Netherlands,2 UK2 and the …

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  • Competing interests HG is part of a team conducting a non-inferiority trial of antibiotics versus watchful waiting in aboriginal children with acute otitis media without perforation in low-risk settings in Australia.