Meta-Analysis Methodology

Study criteria for inclusion:

• Seven reviewers independently analyzed studies for quality of methodology.

• Subjects in all studies were randomly assigned to short (fewer than seven days) or long (seven days or more) of antibiotic treatment.

Definitions for outcomes within 31 days after initiating antibiotic therapy.

• Treatment success = clinical resolution of acute otitis media. (AOM).

• Treatment failure = lack of resolution or recurrence of AOM.

Study subject characteristics:

• Children older and younger than 2 (Age data were obtained for 57% of the subjects. Of these, 45% were younger than 2.)

• Children with intact and with perforated eardrums.

• Children with tympanometry or tympanocentesis (found uncommon).

Re-evaluation of subjects

• From 8-19 days after beginning trial: 1,000 children.

• From 8-19 days and again from 20-30 days: 462 children.

• From 20-30 days after beginning trial: 1,653 children.

• Secondary outcomes to determine treatment success or failure were evaluated at 30-40 days and 120 days after beginning trials.

Source: Kozyrskyi AL, Hildes-Ripstein GE, Longstaffe SE, et al. Treatment of acute otitis media with a shortened course of antibiotics. JAMA 1998;279:1736-1741.


Antibiotic Characteristics

For meta-analysis, the researchers grouped the studies by the characteristics of the antibiotic administered to the subjects. This included:

• short-acting oral antibiotics (penicillin V potassium, amoxicillin, cefaclor, cefixime, cefuroxime, cefpodoxime proxetil, cefprozil);

• oral azithromycin;

• and intramuscular ceftriaxone.

In addition:

• 17 subjects used short-acting antibiotics;

• four subjects used ceftriaxone sodium;

• and one subject used azithromycin.

Source: Kozyrskyi AL, Hildes-Ripstein GE, Longstaffe SE, et al. Treatment of acute otitis media with a shortened course of antibiotics. JAMA 1998;279:1736-1741.