Analysis of Antibiotic Use for Preventing Recurrent Acute Otitis Media

This report presents a meta-analysis of the use of antibiotics in preventing recurrent acute otitis media (AOM) and treating otitis media with effusion (OME). The research addresses concerns regarding antibiotic use in children with otitis media, evaluating the magnitude of treatment effects, optimal antibiotic choices, and the impact of patient characteristics. The study analyzes data from various clinical trials and studies, assessing the effectiveness of antibiotics in preventing AOM recurrence and resolving OME. Findings suggest limited benefits of antibiotics in the long-term for OME, but prophylaxis is beneficial for recurrent AOM. The report also discusses limitations, including the lack of independent data and methodological rigor, highlighting the need for further research to provide more definitive recommendations on antibiotic use in otitis media treatment. The report concludes that antibiotics have limited effect in treatment of OME but beneficial in treatment of recurrent otitis media and resolution of OME in the short run.

USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS MEDIA 1
Use of Antibiotics in Preventing Recurrent Acute Otitis Media and Treating Otitis Media with
Effusion
Student’s Name
Course
Instructor
Date of Submission

USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS MEDIA 2
Introduction
There is an extensive but controversial medical literature on medical resources needed to
address problems related to otitis media. Recently, use of certain antibiotics in children suffering
from otitis media has raised concerns from different quarters. Acute otitis media (AOM) can be
addressed by use of antibiotics or surgical treatment; in which either treatment has certain
benefits and demerits, warranting extensive debates and consultations before settling for one. For
those who propose recurrent antibiotic treatment of recurrent AOM, the choice, timing and the
period of antibiotic prophylaxis are to be resolved. There is uncertainty for otitis media effusion
(OME) as to whether antibiotic offer placebo advantage (Rovers, Schilder, and Zielhuis, 2004 p.
22). The research is aimed at addressing these concerns hence the need for meta-analyses of
antibiotic’s role in porphyries of recurrent AOM and OME treatment.
Research questions that need to be satisfied include; 1. What is the magnitude of the
effect of treatment of prophylactic a suppression of antibiotic of recurrent AOM? 2. what effect
exists, if the details of using an antibiotic choice of timing, duration, and timing offer the highest
beneficial effect. 3. What is a short-term magnitude of treatment effect if any, of OME resolution
with antibiotic, 4. If OME effect exists in the short term. If there are long-term benefits. 5. If
there is a presence of treatment effect with OME, what are the antibiotics optimal use, 6? Does
the treatment vary for either condition by the characteristic of the patient that is known as the
rates influencers of AOM such as group setting, age, socioeconomic status, and season of the
year (Jacobs, Springer, and Crothers, 2001 p. 166)?
Goals for Patients with Recurrent Otitis Media

USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS MEDIA 3
The main goals during treatment of recurrent otitis media include preventing of faster
progression of infectious, addressing AOM complication, preventing hearing prevention deficits
and promoting language development. The antibiotic studies use of either treatment of OME or
prophylaxis of recruitment AOM were identified by MEDLINE during a 1996 search using
refined searching that was linked with the otitis media phase. With one of the following terms;
prospective, clinical trials, random models, placebo, statistical, placebos, the articles that were
identified to help study more about the problems (Harrison, Tyler, Smith, and Findlay, 2004.
P.45); the results confirmed that goals of treatment are as discussed herein.
Methods
Monographs, textbooks and current contents were searched. Use of randomly published
controlled trials of the use of antibiotics in the AOM recurrent or OME was selected. The
estimated effects of the submission and publication of studies with the findings that are null by
the standard approach. The inclusion articles meeting criteria were obliged to conceal the source
of authors, study location, publication and medication use. The results and methods sections
were viewed independently, reviewed by reviewers who rated every article for ideal adherence
characterized by a randomized controlled trial using a rating form that was standard (Hunink,
Weinstein, Wittenberg etl 2014. P. 674). The reviewers also used an additional scoring sheet to
rate the potential of the assessed report of confounding factors such age, race, status, duration,
socioeconomic factors, disease, the previous therapy used for otitis media and the first episode of
otitis media. Differences between reviewers’ accurate rating on specific items got solutions by
the third blinded reviewer. The evaluation summary scores were rated. Articles that were
selected were used for four meta-analyses separately. For sufficient outcome reports were used
for more than analysis and the authors provided presented more data for more than one outcome.

USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS MEDIA 4
Meta-analyses addressed the use of antibiotics in the prophylaxis of recurrent AOM.
Examining the episode frequency of meta-analyses. These go into the data present the number of
patients per month. The outcome of treatment of OME was reported in this period; the outcome
used the closest to a month after treatment. The patients in this group were in the unit of analysis.
Free effusion for the patient to consider benefited treatment. The report that was similar with an
exception the unit of outcome in the articles was cleared. A more conservative measure of the
outcome the patient. The patient is one of the meta-analysis.
Statistical Analysis
Statistical analysis method DerSimonian analyses were used as well as Laird to calculate
the differences in rates of treatment approximation and the effect at 95% confidence interval
(Kemper, and Cohen, 2004.p 55). The random effect the random effect did not ensure
homogeneity of the study population and incorporated different variability into the estimates.
The effect summary statistics of effect using the approach is measured by terms of error within
every study as the results are shown.
Finding
` The findings of the meta-analysis offer support that is mixed for the use of antibiotics in
the prophylaxis or treatment of OME and the recurrent AOM. Prophylaxis treatment works best
for children with AOM intermittent with regards to prevention of AOM. The effect was limited
by treatment requirement in which it showed ten children desirable treatment outcomes (Tan,
Brainard, and Larkin, 2015 p. 455). However, the small RD is necessary to stand out given the
nature of antitoxic and attraction risk (surgical treatment)

USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS MEDIA 5
There is lack of sufficient indication to recommend a particular antibiotic, although using
sulfisoxazole seems to have better treatment outcomes compared with other antibiotics. The
insufficient evidence fails to provide a recommendation on the treatment duration or the effect of
the recurrence rates of AOM before therapy. For the case of OME, the antibiotics appear to be
useful in a short course or short-term effusion clearance. With regard as to whether one considers
it being the outcome of treatment. The effect is limited; however other patients need to be treated
to improve the result in one of them and relatively short duration. In in a month or more after
completion of treatment, there is no statistical improvement in comparison with control.
Prevention of delays in language development is the major goal of OME treatment as
well as general realization of developmental milestones that may be delayed by hearing deficits.
Lack of effectiveness in treatment, in the long term, leads to questioning the value of antibiotic
treatment with regards to its administration to achieve its goals. Language is not acquired in the
short term interval. If there is persistence in the antibiotic treatment for a short duration, the goal
may not be achieved. Additionally, recent studies conducted with placebo control tend to
indicate lesser short-term antibiotic benefits. With meta-analysis, the findings reported herein
rely on the concluded studies in the analysis. Two of the analyses suggest that those of the
current otitis media and of OME with the outcome of measure involving the use of data that are
not entirely independent. The results of the research could come more than once in one child
since raw data was not available. However, since raw data was not available to address the
question, and since methodology was not approached statistically through meta-analysis, type
two errors were not excluded properly.
Very few studies consider a few of the many potential factors that were confounded in
the survey design. These analyses were also unable to address the question about how the

USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS MEDIA 6
characteristics of the patient influenced the effect of treatment. The lack of methodological rigor
in the study included as indicated by the low-quality scores were considered as findings
limitation. The study quality, however, shows that over and above assignment of patients
randomly to treatment to be as considered finding’s limitation. The correction of the survey on
the quality over and above the treatment of patients to be compared.
Quantitative review
The pooled showed findings an RD favoring the treatment of the antibiotic of 0.11 OAM
episodes patient –month (CI, 0.03 to 0.19 95%) the control in the group was 0.19. The pooled
findings showed an RD favoring treatment of 0.11 events. The control rate groups were 0.19 (CI,
0.13 TO 0.26 95%). Three studies with 121 subjects in a total used crossover design. Excluding
the crossover of the studies produced no change. Studies that used sulfisoxazole had a trend a
better outcome (RD, 0.20;95%) (Young, Peppard, and Gottlieb, 2002.p 1218)
OME Treatment, long tern common effects. The meta-analysis 4. In the meta-analysis,
eight students were included 0f short-term to long-term outcome of the treatment of OME with
antibiotics. Five studies had the results of favoring the treatment of antibiotic and three studies
supported placebo, and two showed a small difference or no difference at all. One had CIs that
zero was inclusive. In a pooled analysis it was found that little evidence for long-term or average
benefit from antibiotic from antibiotic treatment of OME. When there was a division of studies
by the use of ear or the patient as the outcome the results remained the same. With the patient the
RD was o. o1 (95% CI, 0.06-0.08); with the ear was 0.12 (95% CI, 0.14 TO 0.26). Elimination
on the study using the antibiotic of efficiency that is questionable (penicillin) did not affect the
findings. Likewise, the division of the studies by the treatment duration.

USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS MEDIA 7
Summary and Recommendations
Gens tends to produce treatment effects than the other antibiotics better; the statistical
differences are not significant. Regarding the term of the therapy, no trend is the apparent or
preexisting disease. These are with reason that the primary goal of OME treatment is preventing
language or developmental delays due to the deficit of earing. The lack of long-term
effectiveness results to one questioning the value of antibiotic treatment as it is currently
administered in achieving this goal (Schneeweiss, 2007, p.144). In the short interval of time
language is not acquired. If there is the persistence of antibiotic treatment for a short period only
the goal my not achieved. Additionally, more recent studies and the studies conducted with
controls placebo tended to show secondary benefits in short-term of the antibiotics.
With any meta-analysis, the reported findings herein show on the studies in the analysis
that was concluded. Three of the meta-analyses of those otitis media and OME that was recurrent
with the ear as the measure of the outcome. The involvement of the use of the data that are not
independent fully. The outcome under study occurred more than once in the same child. Since
the used data was raw from the studies were unavailable, the statistical correction could not be
appropriate and cloud not be the correction for this unknown dependency level (Thomas, and
Witte, 2002, p. 510). The approach used is conservative in the correction for dependence would
have resulted to narrow CIs.
As the studies disagree on the duration of treatment, it’s possible that combining the
results from all the studies may affect the difference between the results response curves at
distinct points in time. However, since there was no raw data in the study to address the question
and methodology did not exist to give the correction; as such straight-line was selected in
response curves. Finally, there is currently no approach that is standard to calculating power for

USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS MEDIA 8
statistics summary obtainable through meta-analysis leading to exclusion of type II possibility in
some of the null comparisons (Roberts, Rosenfeld, and Zeisel, 2004, p.240). The study design
factors were very few that produces low scores. The limitation of the findings correction of the
quality study over and above assignment is randomly given to patients to the treatment that is
compared has not altered the results. When it has been done in the different meta-analysis and
found no correlation between observed RD and quality (Welcome Trust Case Control
Consortium, 2007 p. 663).
Conclusion
Antibiotics appear to have limited effect in treatment of OME but beneficial in treatment
of recurrent otitis media and resolution of OME in the short run. OME long-term benefits have
not been identified clearly. Most studies seem to be failing to consider their potential to produce
usable recommendations. This has contributed to the inability to determine groups of patients’
that are most likely to benefit. There is uncertainty whether antibiotic treatment for otitis media
with OME effusion offer any benefit over placebo. The meta-analysis in prophylaxis antibiotics
of recurrent AOM and OME treatment attests to that.

USE OF ANTIBIOTICS IN PREVENTING RECURRENT ACUTE OTITIS MEDIA 9
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