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Is it Necessary?

Larry Culpepper, MD, MPH; Jack Froom, MD

JAMA. 1997;278(20):1643-1645.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

EVIDENCE THAT routine antimicrobial treatment improves the course and outcomes after acute otitis media is weak. Given the lack of evidence for benefit and the potential for adverse effects, including altering normal respiratory flora and development of resistant organisms, routine treatment using 10 days of antimicrobials for all cases of acute otitis media is not warranted.

See also p 1640.

There have been 7 randomized, blinded, placebo-controlled trials of acute otitis media over the past 30 years. Neither short- nor long-term differences were demonstrated in 3,^1-3 and minor differences noted in the other 4 studies were limited to short-term benefits of antimicrobials.^4-7 In a study by Howie and Ploussard,⁴ all case patients receiving placebo were asymptomatic at early follow-up (2 to 7 days) but had more positive tympanocentesis cultures than those receiving antimicrobials. Mygind et al⁵ found decreased pain in the penicillin group compared with the . . . [Full Text PDF of this Article]

Author Affiliations
From the Department of Family Medicine, Boston University School of Medicine, Boston, Mass (Dr Culpepper); and the Department of Family Medicine, School of Medicine, State University of New York at Stony Brook (Dr Froom).

Footnotes
Reprints: Larry Culpepper, MD, MPH, Department of Family Medicine, Boston University School of Medicine, One Boston Medical Center Place, Boston, MA 02118.

Controversies section editor: Phil B. Fontanarosa, MD, Senior Editor.

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RELATED LETTER

Controversies: Treatment of Acute Otitis Media
Michael J. Harkness, Asa Melhus, Ann Hermansson, Richard M. Rosenfeld, Jack L. Paradise, Jack Froom, Larry Culpepper, and Jack L. Paradise
JAMA. 1998;279(22):1783-1785.
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