Delayed prescribing of antibiotics increased duration of acute otitis media symptoms in children but reduced diarrhoea
QUESTION: Is a delayed (72 hour “wait and see”) prescribing strategy for antibiotics as effective as standard immediate prescribing for children with acute otitis media (AOM)?
Randomised (unclear allocation concealment), unblinded, controlled trial with about 1 week of follow up.
General practices in south west UK.
315 children aged 6 months to 10 years (59% >3 y) who had acute otalgia and otoscopic evidence of acute inflammation of the ear drum. Exclusion criteria were otoscopic appearances consistent with crying or fever alone (pink ear drum only), appearances more suggestive of OM with effusion and chronic suppurative OM, serious chronic disease, use of antibiotics for ear infections in the previous 2 weeks, previous complications, or if the child was too unwell to be left to wait and see. 285 children (90%) were included in the analysis.
All patients were prescribed amoxicillin syrup, 125 mg in 5 ml, 3 times daily, 100 ml in total, except for patients allergic to penicillin who were prescribed erythromycin, 125 mg in 5 ml, 4 times daily for 1 week. 164 children were allocated to delayed prescription of antibiotics. …