University Report: Systematic Review of AOM Treatment Options

This report presents a systematic review of the treatment of acute otitis media (AOM) in children. The research aimed to compare the efficacy of no medication versus primary line therapy, primarily antibiotics, within the first month of diagnosis. The methodology involved a literature search of databases like CINAHL and PubMed, with specific inclusion criteria for relevant studies published between 2010 and 2016. The review analyzed four papers, including studies by Te Molder et al. (2016), Ghosh and Chatterjee (2017), Venekamp et al. (2015), and Tähtinen et al. (2012). The findings suggest that antibiotics are effective in treating AOM in children under two years old and may prevent recurrence, although the efficacy for older children is less clear. The review highlights the importance of distinguishing between AOM cases that benefit from antibiotics and those that do not, emphasizing the need for further research to clarify the role of antibiotics in children aged 2-10 years. The report concludes with a summary of the evidence, interpreting the pros and cons of antibiotic treatment and recommending further studies.

SUMMARY OF
THE
SYSTEMATIC
REVIEW
RESULTS
NAME OF THE STUDENT
NAME OF THE UNIVERSITY

RESEARCH OBJECTIVE
The main aim of this presentation are as
follows:
• To examine the issue of acute otitis
media in children and compare the
efficacy of no medication compared to
primary line therapy in treating children
in the first month of diagnosis
• To conduct a systematic review on the
topic and presents the findings of the
articles
• To discuss and interpret the results
obtained from the selected articles.

OVERVIEW OF THE TOPIC
 Acute Otitis media (AOM) is an
inflammatory disease that is associated
with fluid build up in the middle ear
 The common symptom of otitis media
includes pain and fever. However, non-
specific symptoms in children included
rhinitis, headache, diarhheoa, vomiting
and fever (Leach & Morris, 2006).
 There is a need to distinguish between
AOM that can be treated with antibiotics
versus those which are treated with
effusion.

RESEARCH PROBLEM
 There is a need to find effective
treatment for AOM in infants as
improper treatment can lead to severe
complications
 There is great controversy regarding the
use of antibiotics for treatment.
 There is mixed evidence regarding the
outcome of antibiotics versus other
treatment thus suggesting the need to
conduct a systematic review of high
quality papers.

RESEARCH QUESTION
The research that guided the systematic
review includes the following:
In children with acute otitis media (P), is
the use of no medication (I) more
effective in reducing the duration of
symptoms (O) as compared to a primary
line therapy (C) within the first month of
diagnosis (T)?

SEARCH STRATEGY
 The search for data was done in
database like CINAHL and PubMed.
 The key search term used for literature
search included ‘acute otitis media’,
‘children’, ‘antibiotics’ and primary line
therapy
 The inclusion criteria was to select those
papers which were published from 2010
to 2016
 Only those studies were taken which
came under level I or level II in the
hierarchy of research evidence

SEARCH RESULTS
 After full text review and comparison of
the papers based on inclusion criteria
and research question, total 55 articles
were retrieved.
 Out of this, 5 articles were found to be
duplicate
 20 articles were excluded as they did
not addressed the research question
 Out of 30 article, four papers were found
to answer the research question and
fulfill eligibility criteria

OVERVIEW OF THE
RESULTS
 The main findings by Te Molder et al.
(2016) was that it revealed that
antibiotic treatment is effective in
preventing future recurrence of AOM
episodes.
 Out of 848 children, 512 were
prescribed antibiotics
 The long term follow up study gave valid
evidence for efficacy of antibiotic
treatment for first AOM episode during
infancy
Level of evidence: Level 2 (prospective

OVERVIEW OF THE
RESULTS
 The study by Ghosh and Chatterjee
(2017) evaluated the efficacy and safety
of efpodoxime and amoxicillin-
clavulanate potassium to treat AOM in
children below two years
 The clinical success rate was found to
be 93.8% in efpodoxime group and 88%
in amoxicillin-clavulanate potassium
group
 The study proved that antibiotic course
is effective for children below two years
Level: II (Prospective longitudinal study)

OVERVIEW OF THE
RESULTS
 The study by Venekamp et al. (2015)
compared the efficacy of antibiotics
versus placebo in children with AOM.
 By using systematic review method, the
study revealed that antibiotics was not
effective for children.
 The rate of children with pain did not
decreased and there was lack of
evidence to identify if antibiotics
prevented rare complications in patient
Level: I (Systematic review)

OVERVIEW OF THE
RESULTS
 Tähtinen et al. (2012) used prospective
study design to investigate about the
topic by evaluating efficacy of
antibiotics versus placebo in 6 to 35
months children
 Improvement in symptom was observed
for 96% of children
 The study also proved that delayed
antibiotic administration cannot affect
clinical condition of patients.
Level: Level 1 (RCT)

CONCLUSION
From the critical analysis of the four
papers, it can be concluded that:
• Antibiotic is effective in treatment of
AOM in children below 2 years
• Antibiotic treatment has long-term
efficacy
• The efficacy of antibiotics for children
older than 2 years is not clear

RECOMMENDATION
 The findings from the review can be
used to interpret the pros and cons of
antibiotic treatment for children with
AOMs
 It is recommended to conduct future
studies to evaluate the role of
antibiotics for children aged above 2-10
years

REFERENCES
GhoSh, A. & ChAtterjee, S., (2017). Comparison of efficacy and safety of
cefpodoxime and amoxicillin-clavulanate potassium in paediatric acute
otitis media in children below two years: a prospective longitudinal
study. Journal of Clinical and Diagnostic Research: JCDR, 11(6), p.FC01.
Leach, A. J., & Morris, P. S. (2006). Antibiotics for the prevention of acute
and chronic suppurative otitis media in children. Cochrane Database of
Systematic Reviews, 1(4), 1-96.
http://dx.doi.org/10.1002/14651858.CD004401.pub2.
Tähtinen, P. A., Laine, M. K., Ruuskanen, O., & Ruohola, A. (2012).
Delayed versus immediate antimicrobial treatment for acute otitis
media. The Pediatric infectious disease journal, 31(12), 1227-1232.
Te Molder, M., de Hoog, M. L., Uiterwaal, C. S., van der Ent, C. K., Smit, H.
A., Schilder, A. G., ... & Venekamp, R. P. (2016). Antibiotic treatment for
first episode of acute otitis media is not associated with future
recurrences. PloS one, 11(9), e0160560.
Venekamp, R.P., Sanders, S.L., Glasziou, P.P., Del Mar, C.B. & Rovers,
M.M., (2015). Antibiotics for acute otitis media in children. Cochrane
database of systematic reviews, (6).