Introduction: Acute otitis media (AOM) is a common childhood illness -which frequently results in a prescription for an antibiotic. In North America, the Standard treatment of AOM is a 10-day course of antibiotics- However, a shortened course of antibiotics may decrease costs and the risk of developing resistant bacteria.

Objective: To conduct a meta-analysis of RCTs of the antibiotic treatment of AOM in children, with the primary objective of determining whether clinical resolution following treatment with antibiotics for <7 days was equivalent to treatment for> 7 days.

Methods: Trials of the antibiotic treatment of AOM were identified in the medical literature and assessed for inclusion according to the following criteria: I month to 18 years of age, clinical diagnosis of AOM, and randomization to treatment with <7 days of antibiotics or> 7 days. The methodologic quality of included trials was assessed (Jadad scale) by 7 reviewers. Outcome data, documented as the number of treatment failures, were extracted from individual trials, and the cumulative odds ratio and risk difference were calculated using a fixed effects model. Sensitivity analyses were conducted to assess the robustness of the meta-analysis.

Results: Eighteen trials (mean quality score = 2.7, SD= 1 -0) met inclusion criteria and were grouped by antibiotic used in the short treatment arm (1. shortacting antibiotics, eg cefaclor 2.ceftriaxone 3. azithromycin). The _<1 month outcome (OR="1.17," 95% CI-0.89-1.53) and < 3 month outcomes (OR="0.9," 95% CI="0.59-1.37)" of treatment with 5 days of short-acting antibiotics were not significantly different from treatment with>7 days No differences in outcome between treatment arms were shown for the ceftriaxone and azithromycin groups. Sensitivity analyses confirmed the robustness of the meta-analysis of the short-acting antibiotic group.

Discussion: The results of this meta-analysis show that 5 days of short-acting antibiotic is effective treatment for AOM in children.