Clinical Practice Guidelines for Managing Acute Otitis Media: Literature Review and Systematic Mapping of the Evidence Base

Background

Clinical practice guidelines (CPGs) for managing acute otitis media (AOM) have heterogeneous treatment recommendations. We hypothesized that this variability may be due to differences in the evidence cited to support the recommendations, and we first wanted to investigate whether this difference existed.

Objective

To analyze the studies on which different national and international CPGs are based regarding the indication for antibiotic therapy in patients with AOM.

Methods

We included and analysed European and North American CPGs for the management of AOM. For each CPG, we identified the studies cited to justify antimicrobial prescribing. For each individual study, we extracted the main study features, including the study design, and its publication date. Two independent reviewers carried out study selection and data extraction.

Results

A total of 15 CPGs for AOM were included. In total, 76 different studies were cited to justify antimicrobial prescribing (median of 8 studies cited, range 1–23). Among these studies, randomized controlled trials were the most frequent (19/76, 25%), followed by systematic reviews with meta-analysis (16/76, 21%). Some CPGs (5/15, 33%) cited more than two systematic reviews with meta-analysis; two CPGs cited no systematic review (with or without meta-analysis). Most studies (53/76, 69%) were cited by only one of the 15 CPGs.

Conclusions

In this review of CPGs, we found considerable variability in the quantity and type of studies cited to justify the recommendation to use antibiotics in AOM. These findings question one of the core principles of evidence-based medicine and its application to everyday clinical practice.