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Systematic review
Antibiotics administered for acute otitis media have modest benefits and adverse effects
  1. Jennifer J Shin
  1. Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to: Professor Jennifer J Shin, Department of Otolaryngology, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA; jennifer_shin{at}

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Acute otitis media (AOM) is a highly prevalent condition, with 50–85% of children affected by 3 years of age.1 Cases may spontaneously remit, but may also culminate in pain, fever, tympanic membrane perforation or mastoiditis. Antibiotic usage varies worldwide, and these data inform this decision by assessing the impact of: (1) antibiotics compared to placebo, (2) immediate antibiotics compared to expectant observation and (3) potential effect modifiers.


This systematic review included randomised controlled trials (RCTs) focused on patient-relevant outcomes. Primary outcomes were the proportion of children with: (1) pain at 1, 2–3, 4–7 and 10–14 days, and (2) adverse effects (vomiting/diarrhoea/rash). Secondary outcomes included abnormal tympanometry, tympanic membrane perforation, contralateral AOM, complications of AOM and long-term healthcare utilisation. Searches were undertaken in a litany of databases, and independent extraction was performed. Study quality was assessed according to possible allocation/performance/attrition/other biases; a grading of recommendation, …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.