Clinical question
How effective are once or twice-daily doses of amoxicillin, with or without clavulanate, for the treatment of acute otitis media in children aged 12 years or less?
Bottom line
Treating acute otitis media (AOM) with either once/ twice-daily or 3-times-daily amoxicillin, with or without clavulanate, had the same results, including adverse events such as diarrhoea and skin reactions. The outcome measures were clinical cure rates in terms of resolution of otalgia and fever at the end of antibiotic therapy (days 7–15), middle ear effusion during therapy, and clinical cure rates post-treatment (1–3 months) in terms of resolution of middle ear infection and AOM complications.
Caveat
All of the included studies had an unclear risk of bias for allocation concealment. Three studies had an unclear risk of bias for randomisation, as they did not describe the details of randomisation sequence generation or methods to conceal allocation.
Context
Amoxicillin, with or without clavulanate, is frequently prescribed as a treatment of choice for AOM. The conventional recommendation is either 3 or 4 doses daily.
Cochrane Systematic Review
Thanaviratananich S et al. Once or twice daily versus three times daily amoxicillin with or without clavulanate for the treatment of acute otitis media. Cochrane Reviews, 2013, Issue 12. Art. No.: CD014975.DOI: 10.1002/14651858. CD014975.pub3.
This review contains 5 studies involving 1601 participants.
Cochrane Systematic Reviews for primary care practitioners
Developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health and New Zealand Doctor. PEARLS are meant for educational use and not to guide clinical care. New Zealanders can access the Cochrane Library free via www.cochrane.org.nz
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