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

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!

References

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