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A Systematic Review and Meta-Analysis of the Efficacy of Antimicrobial Chemoprophylaxis for Recurrent Acute Otitis Media in Children

Lookup NU author(s): Zeynep Elcioglu, Dr Michael Mather, Jason PowellORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2024 The Author(s). Clinical Otolaryngology published by John Wiley & Sons Ltd.Objectives: Acute otitis media (AOM) is a common childhood infection. Recurrent AOM affects a subset of children, resulting in an adverse impact on quality of life, socioeconomic disadvantage, and risk of long-term sequelae. Antimicrobial chemoprophylaxis is used in some settings but is increasingly controversial due to an awareness of adverse long-term effects and contribution to global antibiotic resistance. Design and Setting: A comprehensive literature search was undertaken using Medline (1946–October 2023) and Embase (1974–October 2023). The primary aim was to assess the efficacy of antimicrobial chemoprophylaxis on AOM episodes in children < 18 years of age. Bias and quality assessment was performed. Dichotomous data were analysed using risk ratio with 95% confidence intervals. Meta-analysis was carried out using random-effects models for pooled analysis, independent of heterogeneity. Heterogeneity was assessed using the I2 statistic. Main Outcome Measures: The effect of antimicrobial chemoprophylaxis in children with rAOM on the number of individual AOM episodes. Secondary outcomes: assessment of antimicrobial agents and outcomes in children with risk factors. Results: Assessment of qualitative data was performed on 20 studies (n = 2210). No controlled trials were identified post-multivalent pneumococcal conjugate vaccine (PCV) introduction, restricting current generalisability. Quantitative meta-analysis on nine pre-PCV studies (n = 1087) demonstrated antimicrobial chemoprophylaxis reduced any episode of AOM with a risk ratio 0.59 (95% CI 0.45–0.77). Conclusion: Families and clinicians must balance marginal short-medium term benefit (based on pre-PCV data), and the potential for adverse effects to that individual, and the societal risk of antimicrobial resistance with prolonged antibiotic use.

Publication metadata

Author(s): Davies T, Peng X, Salem J, Elcioglu Z, Kremneva A, Gruber M-Y, Milinis K, Mather M, Powell J, Sharma S

Publication type: Review

Publication status: Published

Journal: Clinical Otolaryngology

Year: 2025

Volume: 50

Issue: 1

Pages: 1-14

Print publication date: 01/01/2025

Online publication date: 12/10/2024

Acceptance date: 22/09/2024

ISSN (print): 1749-4478

ISSN (electronic): 1749-4486

Publisher: John Wiley and Sons Inc

URL: https://doi.org/10.1111/coa.14240

DOI: 10.1111/coa.14240

Data Access Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

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