Recurrence up to 3.5 years after antibiotic treatment of acute otitis media in very young Dutch children: survey of trial participants

BMJ 2009; 338 doi: (Published 30 June 2009)
Cite this as: BMJ 2009;338:b2525

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17 July 2009

fully agree with RajivKapil-Bhatinda. Moreover we are interested in, or the goal of patient's visit is that it should not recur and should not become chronic and should not lead to deafness. So studying only recurrence rate does not give full picture of disease - all aspects must show improvement with any intervention. One may add less expensive- short duration about treatment to this goal.

Competing interests: None declared

Competing interests: None declared

Jayendra Gohil, Prof Pediatrics

Bhavnagar India 364002

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In a recent edition of BMJ 2009; 338; b2525 (30 June) Bezáková et al published a research article entitled, ‘Recurrence up to 3.5 years after antibiotic treatment of acute otitis media in very young Dutch children: survey of trial participants’. [1] We found that in the result section, in amoxicillin treated group the denominator used differs at different places; while showing acute otitis media recurrence, denominator used is 75 (47/75); for children referred to secondary care and for children underwent ENT surgery denominator used is 78 (24/78 and 16/78 respectively). Similar are the variations in placebo control group. Denominator used is 86 (37/86), 89 (27/89) and 90 (27/90) for recurrence, secondary reference and surgery cases respectively. This variation might be a numerical error or it might be due to the reason that some parents did not returned completely filled questionnaire. If that is the case, it should have been mentioned in the article.

Moreover, results have wrongly been interpreted in only one way- recurrence of otitis media after antibiotic use. As is obvious from the results, [1] only 21% (16/78) children underwent ENT surgery after antibiotic use in acute otitis media as compared to 30% (27/90) in placebo controlled group; and there is a clear advantage of 9%, which is big reduction in surgical cases.

If we assume that the children who underwent ENT surgery in two groups are the same in which recurrence occurred beforehand (and there are all the reasons to believe this notion), then one will see (Table 1) that the chances of requirement of a future ENT surgery in antibiotic treated- recurrence cases are very less as compared to placebo treated (34% vs 73%). In other words, prior antibiotic use may increase the chances of recurrence, but decreases the chances of requirement of future ENT surgery.

Judicious use of antibiotic is a universal phenomenon and has been recommended for every infection. Reducing/avoiding inappropriate/indiscriminate antibiotic use is thought to be the best way to control resistance. [2, 3] So, there is nothing new in this conclusion. We argue that the conclusion drawn from the study that recurrent acute otitis media occurred more often in the children originally treated with amoxicillin is half truth. Other half of the truth is that children originally treated with amoxicillin require ENT surgery less frequently. So, it’s your choice-Recurrence or Surgery!


1. Bezáková N, Damoiseaux RAMJ, Hoes AW, Schilder AGM, Rovers MM. Recurrence up to 3.5 years after antibiotic treatment of acute otitis media in very young Dutch children: survey of trial participants. BMJ 2009; 338: b2525

2. Chambers HF. General Principles of antimicrobial therapy. In: Brunton LL, Lazo JS, Parker KL. editors. Goodman and Gilman's The pharmacological basis of therapeutics. 11th ed. McGraw-Hill: New York; 2006. p 1095

3. Bennett PN, Brown MJ. Clinical Pharmacology. 9th ed. Churchill Livingstone: Edinburgh; 2003. p 209

Competing interests: None declared

Competing interests: None declared

Rajiv Mahajan, Assistant Professor

Kapil Gupta

Adesh Institute of Medical Sciences & Research, Bathinda (India)-151109

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