Even infants with otitis media do not need antibiotics

Antibiotics are regularly given for otitis media in children despite lack of evidence of their effectiveness. To curb antibiotic resistance it has been suggested that they should be restricted to children under 2. But after a randomised placebo controlled trial in 240 children under 2 Damoiseaux et al conclude that watchful waiting at the first visit is justified for these children as well (p 350). Fever lasted one day less and analgesics were used less often in the amoxicillin group. No differences were observed in the duration of pain or crying. To improve symptoms at day four 7-8 children needed to be treated, and there was no effect at day 11. This minor effect, argue the authors, justifies watchful waiting at the first visit for younger as well as older children.

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Relevant Article

Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years

Roger A M J Damoiseaux, Frank A M van Balen, Arno W Hoes, Theo J M Verheij, and Ruut A de Melker
BMJ 2000 320: 350-354. [Abstract] [Full Text] [PDF]