| Acute otitis media
A systematic review of antibiotics for acute otitis media included 13 RCTs with 3401 children from high-income countries. [12] Early antibiotics compared had no early effect on pain, reduced pain in the days following, and reduced the number of children with tympanic perforations, contralateral otitis episodes and abnormal tympanometry findings at two to four weeks and at six to eight weeks compared with placebo. No serious complications occurred in either the antibiotic or the expectant observation group. Immediate antibiotics were associated with a substantial increased risk of vomiting, diarrhoea or rash (RR 1.71, 95% CI 1.24 to 2.36; NNTH 9). Three trials in 611 infants ≥6 months compared amoxicillin-clavulanic acid up to 90 + 6.8 mg/kg/day for 10 days to placebo and reported reduced pain, contralateral otitis media and abnormal tympanometry at 2 to 4 weeks, but increased vomiting, diarrhoea or rash. Conclusion: The benefits of antibiotics must be weighed against the possible harms: for every 14 children treated with antibiotics one child experienced an adverse event such as vomiting, diarrhoea or rash. Antibiotics are most useful in children under 2 years of age, with bilateral AOM, or with both AOM and otorrhoea. [LOE I GOR B]
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