{"title":"Efficacy of antimicrobials or placebo compared to amoxicillin-clavulanate in children with acute otitis media: a systematic review.","authors":"Katerina Tsergouli, Nikolaos Karampatakis, Theodoros Karampatakis","doi":"10.24953/turkjped.2022.893","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Acute otitis media (AOM) is the inflammation of the middle ear. It constitutes one of the most frequent infections which affects children and usually occurs between 6 to 24 months of age. AOM can emerge due to viruses and/or bacteria. The aim of the current systematic review is to assess in children between 6 months and 12 years of age with AOM, the efficacy of any antimicrobial agent or placebo compared with amoxicillinclavulanate, to measure the resolution of AOM or symptoms.</p><p><strong>Methods: </strong>The medical databases PubMed (MEDLINE) and Web of Science were used. Data extraction and analysis were performed by two independent reviewers. Eligibility criteria were set, and only randomised control trials (RCTs) were included. Critical appraisal of the eligible studies was performed. Pooled analysis was conducted using the Review Manager v. 5.4.1 software (RevMan).</p><p><strong>Results: </strong>Twelve RCTs were totally included. Three (25.0%) RCTs studied the impact of azithromycin, two (16.7%) investigated the impact of cefdinir, two (16.7%) investigated placebo, three (25.0%) studied quinolones, one (8.3%) investigated cefaclor and one (8.3%) studied penicillin V, compared to amoxicillin-clavulanate. In five (41.7%) RCTs, amoxicillin-clavulanate proved to be superior to azithromycin, cefdinir, placebo, cefaclor and penicillin V, while in seven (58.3%) RCTs its efficacy was comparable with other antimicrobials or placebo. The rates of AOM relapse after treatment with amoxicillin-clavulanate were comparable to those of other antimicrobials or placebo. However, amoxicillin-clavulanate was more effective in eradicating Streptococcus pneumoniae from the culture, when compared to cefdinir. The results of the meta-analysis were not evaluated due to substantial heterogeneity between studies.</p><p><strong>Conclusions: </strong>Amoxicillin-clavulanate should be the treatment of choice for children between 6 months and 12 years of age with AOM.</p>","PeriodicalId":49409,"journal":{"name":"Turkish Journal of Pediatrics","volume":"65 3","pages":"351-361"},"PeriodicalIF":0.8000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Turkish Journal of Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.24953/turkjped.2022.893","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Acute otitis media (AOM) is the inflammation of the middle ear. It constitutes one of the most frequent infections which affects children and usually occurs between 6 to 24 months of age. AOM can emerge due to viruses and/or bacteria. The aim of the current systematic review is to assess in children between 6 months and 12 years of age with AOM, the efficacy of any antimicrobial agent or placebo compared with amoxicillinclavulanate, to measure the resolution of AOM or symptoms.
Methods: The medical databases PubMed (MEDLINE) and Web of Science were used. Data extraction and analysis were performed by two independent reviewers. Eligibility criteria were set, and only randomised control trials (RCTs) were included. Critical appraisal of the eligible studies was performed. Pooled analysis was conducted using the Review Manager v. 5.4.1 software (RevMan).
Results: Twelve RCTs were totally included. Three (25.0%) RCTs studied the impact of azithromycin, two (16.7%) investigated the impact of cefdinir, two (16.7%) investigated placebo, three (25.0%) studied quinolones, one (8.3%) investigated cefaclor and one (8.3%) studied penicillin V, compared to amoxicillin-clavulanate. In five (41.7%) RCTs, amoxicillin-clavulanate proved to be superior to azithromycin, cefdinir, placebo, cefaclor and penicillin V, while in seven (58.3%) RCTs its efficacy was comparable with other antimicrobials or placebo. The rates of AOM relapse after treatment with amoxicillin-clavulanate were comparable to those of other antimicrobials or placebo. However, amoxicillin-clavulanate was more effective in eradicating Streptococcus pneumoniae from the culture, when compared to cefdinir. The results of the meta-analysis were not evaluated due to substantial heterogeneity between studies.
Conclusions: Amoxicillin-clavulanate should be the treatment of choice for children between 6 months and 12 years of age with AOM.
背景:急性中耳炎(AOM)是一种中耳炎症。它是影响儿童的最常见感染之一，通常发生在6至24个月大之间。AOM可由病毒和/或细菌引起。当前系统评价的目的是评估6个月至12岁的AOM患儿，与阿莫西林inclavulanate相比，任何抗菌药物或安慰剂的疗效，以测量AOM或症状的消退。方法:采用医学数据库PubMed (MEDLINE)和Web of Science。数据提取和分析由两名独立审稿人进行。设定入选标准，仅纳入随机对照试验(RCTs)。对符合条件的研究进行了严格的评估。使用Review Manager v. 5.4.1软件(RevMan)进行汇总分析。结果:共纳入12项rct。3项(25.0%)随机对照试验研究了阿奇霉素的影响，2项(16.7%)研究了头孢地尼的影响，2项(16.7%)研究了安慰剂的影响，3项(25.0%)研究了喹诺酮类药物的影响，1项(8.3%)研究了头孢克洛，1项(8.3%)研究了青霉素V与阿莫西林-克拉维酸的影响。在5项(41.7%)随机对照试验中，阿莫西林-克拉维酸被证明优于阿奇霉素、头孢地尼、安慰剂、头孢克洛和青霉素V，而在7项(58.3%)随机对照试验中，其疗效与其他抗菌剂或安慰剂相当。阿莫西林-克拉维酸治疗后AOM复发率与其他抗菌剂或安慰剂相当。然而，与头孢地尼相比，阿莫西林-克拉维酸在从培养物中根除肺炎链球菌方面更有效。由于研究之间存在很大的异质性，因此未对meta分析的结果进行评估。结论:阿莫西林-克拉维酸盐是6个月~ 12岁急性中耳炎患儿的首选治疗药物。
期刊介绍：
The Turkish Journal of Pediatrics is a multidisciplinary, peer reviewed, open access journal that seeks to publish research to advance the field of Pediatrics. The Journal publishes original articles, case reports, review of the literature, short communications, clinicopathological exercises and letter to the editor in the field of pediatrics. Articles published in this journal are evaluated in an independent and unbiased, double blinded peer-reviewed fashion by an advisory committee.
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