THERAPY

14

Meta-analysis of antibacteria1s

in oti& media

The clinical efficacy of antibacterials in otitis media was evaluated by US researchers Dr Richard M Rosenfeld and colleagues, who reviewed data from 5400 paediatric patients. While data from the meta-analysis indicates that antibacterials should be part of initial empirical therapy for children with otitis media, Rosenfeld et al. found that 'six of every seven children with ADM

I acute otitis medial either do not need antibiotics for primary control or will not respond to antibiotic therapy'. These findings apply only to initial treatment of simple, uncomplicated otitis media with empirically selected antibacterials in children older than 4 weeks of age, explain Rosenfeld and colleagues. They consider that the decision to prescribe antibacterials in this context should be guided by safety, tolerability, and cost, rather than by the theoretical advantage of an extended antibacterial spectrum. Rosenfeld et al. advocate greater cooperation between general practitioner and parents in treatment decisions, in view of the 'modest impact' of antibacterial therapy observed in this analysis, and the potential adverse effects associated with treatment.l

Focu.Wng on the individual child Meta-analysis of this controversial topic has inherent limitations, comment the editors of the Journal of Pediatrics, Drs Harvey J Hamrick and Joseph M Garfunkel. 'It would be wrong to conclude that only

one in seven children . .. would benefit from antimicrobial therapy' , they say in their commentary,

published alongside the meta-analysis. Hamrick and Garfunkel consider that the physician's overriding concern must be for appropriate diagnosis and safe and effective management of the individual child with otitis media. Such management should include appropriate anti-infectives if a bacterial cause is a reasonable suspicion, they conclude?

[See also this issue, p5; 800293640]

1. Rosenfeld RM, ct aI. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. Journal of Pediatrics 124: 355-367, Mar 1994 2. Hamrick HJ, ct aI. Therapy for acute otitis media: applicability of metaanalysis to the individual patient Journal of Pediatrics 124: 431, Mar 1994 10026'' '

30 Apr 1994INPHARMA·

0156-2703194/0935-000141$1.00" Adlalnlernatlonal Limited 1994. All rlghta r_rved