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Increased clinical failures when treating acute otitis media with macrolides: a meta-analysis.
Ann Pharmacother. 2010 Mar; 44(3):471-8.AP

Abstract

BACKGROUND

Macrolide antibiotics are often used to treat children with acute otitis media (AOM); however, the 2004 American Academy of Pediatrics (AAP) and American Academy of Family Physicians guidelines recommend against their use in patients without history of a type I allergic reaction to penicillins.

OBJECTIVE

To evaluate via meta-analysis the comparative efficacy of amoxicillin or amoxicillin/clavulanate to that of macrolide antibiotics in the treatment of children with AOM.

METHODS

A systematic literature search of MEDLINE, EMBASE, and International Pharmaceutical Abstracts was conducted from the earliest available date through September 2008. We used the following MeSH and key words: amoxicillin, amoxicillin/clavulanate, Augmentin, azithromycin, ceftriaxone, clarithromycin, macrolides, AND media, otitis media, and effusion. Included studies were randomized, blinded, and controlled trials evaluating guideline-recommended antibiotics (amoxicillin or amoxicillin/clavulanate) compared to macrolide antibiotics (azithromycin or clarithromycin) in AOM in children. The primary outcome assessed was clinical failure measured between days 10 and 16 after starting antibiotic therapy. Results are reported as relative risks (RRs) with 95% confidence intervals and were calculated using a random-effects model.

RESULTS

A total of 10 trials (N = 2766) evaluating children 6 months-15 years old were included in the meta-analysis. Upon meta-analysis, the use of macrolide antibiotics was associated with an increased risk of clinical failure (RR 1.31 [95% CI 1.07 to 1.60]; p = 0.008) corresponding to a number needed to harm of 32. Upon safety analysis, rates of any adverse reaction (RR 0.74 [95% CI 0.60 to 0.90]; p = 0.003) and diarrhea (RR 0.41 [95% CI 0.32 to 0.52]; p < 0.0001) were significantly lower in the macrolide group.

CONCLUSIONS

The meta-analysis suggests that patients treated with macrolides for AOM may be more likely to have clinical failures. As such, it supports the current AAP AOM recommendation that macrolides be reserved for patients who can not receive amoxicillin or amoxicillin/clavulanate.

Authors+Show Affiliations

Connecticut Children's Medical Center, Hartford, CT 06106, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis

Language

eng

PubMed ID

20150506

Citation

Courter, Joshua D., et al. "Increased Clinical Failures when Treating Acute Otitis Media With Macrolides: a Meta-analysis." The Annals of Pharmacotherapy, vol. 44, no. 3, 2010, pp. 471-8.
Courter JD, Baker WL, Nowak KS, et al. Increased clinical failures when treating acute otitis media with macrolides: a meta-analysis. Ann Pharmacother. 2010;44(3):471-8.
Courter, J. D., Baker, W. L., Nowak, K. S., Smogowicz, L. A., Desjardins, L. L., Coleman, C. I., & Girotto, J. E. (2010). Increased clinical failures when treating acute otitis media with macrolides: a meta-analysis. The Annals of Pharmacotherapy, 44(3), 471-8. https://doi.org/10.1345/aph.1M344
Courter JD, et al. Increased Clinical Failures when Treating Acute Otitis Media With Macrolides: a Meta-analysis. Ann Pharmacother. 2010;44(3):471-8. PubMed PMID: 20150506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased clinical failures when treating acute otitis media with macrolides: a meta-analysis. AU - Courter,Joshua D, AU - Baker,William L, AU - Nowak,Katherine S, AU - Smogowicz,Lori A, AU - Desjardins,Lindsey L, AU - Coleman,Craig I, AU - Girotto,Jennifer E, Y1 - 2010/02/11/ PY - 2010/2/13/entrez PY - 2010/2/13/pubmed PY - 2010/5/19/medline SP - 471 EP - 8 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 44 IS - 3 N2 - BACKGROUND: Macrolide antibiotics are often used to treat children with acute otitis media (AOM); however, the 2004 American Academy of Pediatrics (AAP) and American Academy of Family Physicians guidelines recommend against their use in patients without history of a type I allergic reaction to penicillins. OBJECTIVE: To evaluate via meta-analysis the comparative efficacy of amoxicillin or amoxicillin/clavulanate to that of macrolide antibiotics in the treatment of children with AOM. METHODS: A systematic literature search of MEDLINE, EMBASE, and International Pharmaceutical Abstracts was conducted from the earliest available date through September 2008. We used the following MeSH and key words: amoxicillin, amoxicillin/clavulanate, Augmentin, azithromycin, ceftriaxone, clarithromycin, macrolides, AND media, otitis media, and effusion. Included studies were randomized, blinded, and controlled trials evaluating guideline-recommended antibiotics (amoxicillin or amoxicillin/clavulanate) compared to macrolide antibiotics (azithromycin or clarithromycin) in AOM in children. The primary outcome assessed was clinical failure measured between days 10 and 16 after starting antibiotic therapy. Results are reported as relative risks (RRs) with 95% confidence intervals and were calculated using a random-effects model. RESULTS: A total of 10 trials (N = 2766) evaluating children 6 months-15 years old were included in the meta-analysis. Upon meta-analysis, the use of macrolide antibiotics was associated with an increased risk of clinical failure (RR 1.31 [95% CI 1.07 to 1.60]; p = 0.008) corresponding to a number needed to harm of 32. Upon safety analysis, rates of any adverse reaction (RR 0.74 [95% CI 0.60 to 0.90]; p = 0.003) and diarrhea (RR 0.41 [95% CI 0.32 to 0.52]; p < 0.0001) were significantly lower in the macrolide group. CONCLUSIONS: The meta-analysis suggests that patients treated with macrolides for AOM may be more likely to have clinical failures. As such, it supports the current AAP AOM recommendation that macrolides be reserved for patients who can not receive amoxicillin or amoxicillin/clavulanate. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/20150506/Increased_clinical_failures_when_treating_acute_otitis_media_with_macrolides:_a_meta_analysis_ L2 - https://journals.sagepub.com/doi/10.1345/aph.1M344?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -