Inpharma 1346 - 13 Jul 2002

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Paediatric otitis media: who to treat with antibacterials? Paediatric patients with otitis media without the systemic features of vomiting or high temperature are unlikely to benefit from antibacterial treatment, according to researchers from the UK.1 317 infants and children aged 6 months to 10 years with acute otalgia and otoscopic evidence of acute inflammation were randomised to receive immediate or delayed treatment with antibacterials. The antibacterial used was either amoxicillin or erythromycin and the delay period was 72 hours. Patients who had a temperature of > 37.5°C or vomiting on day 1 were more likely to have a poor outcome (distress and/or disturbed nights) by day 3. When considering those with high temperature or vomiting on day 1, significantly more patients had distress (53%) and disturbed nights (59%) at day 3 when antibacterial use was delayed, compared with immediate antibacterial use (32% and 26%, respectively). This difference was not observed for patients without the systemic symptoms. ‘The results support doctors discussing the likely benefit of antibiotics in systemically unwell children and possibly shortening the delay period from 72 hours to 48 or 24 hours’, comment the researchers. In an accompanying editorial, Drs Chris Del Mar and Jenny Doust from the University of Queensland Medical School, Australia, point out that the study only addresses one of two important vectors of illness in spontaneously remitting illness.2 Specifically, the researchers have analysed the duration of the illness but overlooked its severity. Combining the two vectors gives the measure of "severity days" which is a more accurate indicator of disease impact, comment Drs Del Mar and Doust. They believe that by measuring only one axis, the researchers have considerably underestimated the efficacy of the antibacterials. They also note that, as one of the interventions was no antibacterials (for 3 days), the children recruited are probably not very ill. 1. Little P, et al. Predictors of poor outcome and benefits from antibiotics in children with acute otitis media: pragmatic randomised trial. BMJ 325: 22-24, 6 Jul 2002. 2. Del Mar C, et al. Commentary: research directions for treatment for acute otitis media. BMJ 325: 24, 6 Jul 2002. 800888392

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Inpharma 13 Jul 2002 No. 1346