Part 3Comparison Table Representative Comparisons from Systematic Reviews

StudyComparison primary subgroupOutcomeTrialsParticipantsOR, RD, RR, or WMD95% CI
Marcy (2001)17amp/amox vs no abRx failure 2–7d51518RD −12.3%−21.8 % to −2.8%
pcn vs amp/amoxRx failure 7–14d3491RD 4.5%−1.8% to 10.7%
cefaclor vs amp/amoxRx failure 3–7d4185RD −5.4%−15.2% to 4.4%
Rx failure 5–21 d5315RD 0.5%−5.7% to 6.8%
cefixime vs amp/amoxRx failure 10–15d4519RD −0.1%−4.2% to 3.9%
recurrence 3–5wk3144RD 1.6%−5.1 % to 8.4%
diarrhea5754RD 8.4%3.8% to 13.1%
vomiting5754RD 2 %0% to 4%
rash4714RD 5.8%−2.4% to 13.9%
ceftriaxone vs amoxRx failure 5–10d3306RD 3.4%−1.6% to 8.5%
azith vs amox-clavRx failure 10–14d51045RD 2.1%−0.6% to 4.8%
any adverse effect31366RD −19.2%−29.2% to−9.2%
GI adverse effect31366RD −18.0%−28.0% to−8.0%
Rosenfeld (1994)18pcn vs no abRx failure 7–14d2242RD −15.7%−26.7% to−4.7%
aminopcn vs no abRx failure 7–14d3386RD −12.9%−19.0% to −6.8%
any ab vs no abRx failure 7–14d4535RD −13.7%−19.2% to −8.2%
amp vs pcnRx failure 7–14d3497RD −6.8%−15.2% to 1.5%
amp vs pcn/ssxRx failure 7–14d3462RD 0.9%−7.6% to 9.4%
aminopcn vs eryRx failure 7–14d3525RD 3.1%−3.9% to 10.2%
aminopcn vs tmp-smxRx failure 7–14d2275RD 0.2%−8.8% to 9.2%
amox vs cefaclorRx failure 7–14d4453RD 6.4%−10.2 to 22.9%
amox vs cefiximeRx failure 7–14d3404RD −3.9%−10.4 to 2.6%
MEE 30dNot reportedNot reportedRD −15.0%−35.5% to 5.5%
cefaclor vs ery/ssxRx failure 7–14d2222RD −7.0%−6.5% to 20.4%
cefaclor vs amox-clavRx failure 7–14d5776RD 2.8%−1.3% to 6.8%
MEE 30dNot reportedNot reportedRD 1.6%−5.1% to 8.3%
cefaclor vs cefiximeRx failure 7–14d4966RD 1.2%−2.4% to 4.7%
MEE 30dNot reportedNot reportedRD 1.8%−19.0% to 22.6%
Damoiseaux (1998)ab vs no ab <2y oldclinical resolution4416OR 1.310.83 to 2.08
Kozyrskyj (2000)19≤48° ab vs >7d abRx failure ≤1m2118OR 2.991.04 to 8.54
>48°≤7d ab vs >7d abRx failure ≤1m123118OR 1.381.15 to 1.66
Rx failure 8–19d51524OR 1.521.17 to 1.98
Rx failure 20–30d92115OR 1.220.98 to 1.54
Rx failure ≤3m51054OR 1.160.90 to 1.50
Rx failure 90d2207OR 1.160.65 to 2.06
Rx failure 30–40d3847OR 1.160.87 to 1.55
<2y oldRx failure ≤1m3118OR 0.710.30 to 1.64
≥2y oldRx failure ≤1m3235OR 1.010.53 to 1.94
perforated TMRx failure ≤1m127OR 3.620.81 to 16.1
non-perforated TMRx failure ≤1m1101OR 1.060.40 to 2.75
include chronic OMRx failure ≤1m92220OR 1.391.15 to 1.70
exclude chronic OMRx failure ≤1m3898OR 1.290.76 to 2.20
include chronic OMRx failure 20–30d71459OR 1.190.93 to 1.51
exclude chronic OMRx failure 20–30d2656OR 1.550.79 to 3.04
only “cured”Rx failure ≤1m113062OR 1.351.14 to 1.59
only “cured”Rx failure 20–30d82059OR 1.241.01 to 1.54
GI adverse effects103576OR 0.540.43 to 0.66
excluding amox-clavGI adverse effects72131OR 1.130.81 to 1.57
ceftriaxoneRx failure ≤1m3671OR 1.250.90 to 1.72
Rx failure ≤3m2312OR 0.910.57 to 1.47
GI adverse effects1402OR 2.891.70 to 4.91
azithromycin 3–5dRx failure ≤1m112593OR 1.090.86 to 1.38
Rx failure 8–19d102569OR 1.110.82 to 1.51
Rx failure 20–30d61254OR 1.020.78 to 1.34
<2y oldRx failure ≤1m2138OR 1.920.73 to 5.04
≥2y oldRx failure ≤1m2656OR 1.340.61 to 2.94
Rx 3dRx failure ≤1m81558OR 1.170.71 to 1.92
include chronic OMRx failure ≤1m71688OR 0.960.70 to 1.31
exclude chronic OMRx failure ≤1m4905OR 1.290.89 to 1.85
include chronic OMRx failure 20–30d4740OR 0.830.57 to 1.21
exclude chronic OMRx failure 20–30d2514OR 1.270.86 to 1.86
Kozyrskyj (2000)only “cured”Rx failure 20–30d4728OR 0.830.59 to 1.16
only “cured”Rx failure ≤1m92067OR 0.700.57 to 0.87
GI adverse effects92818OR 0.260.19 to 0.37
Glasziou (2004)ab vs no abpain 24h4717OR 1.030.76 to 1.39
pain 2–7d92287OR 0.570.45 to 0.73
abnl tympanogram 1m3472OR 0.910.62 to 1.32
abnl tympanogram 3m2370OR 0.750.47 to 1.21
perforation2381OR 0.510.20 to 1.26
vomiting, diarrhea, rash4938OR 1.941.28 to 2.94
contralateral otitis3666OR 0.450.16 to 1.23
late recurrence51669OR 1.000.78 to 1.26
Foxlee (2006)20top anaesth vs placebo25% ↓ pain 10min127RR 1.180.65 to 2.15
25% ↓ pain 20min127RR 1.240.87 to 1.76
25% ↓ pain 30min21127RR 1.371.06 to 1.77
Rovers (2006)22,23ab vs no abpain &/or fever 3–7d61643RD −13%−17% to −9%
<2y oldpain &/or fever 3–7d6567RD −15%−23% to −7%
≥2y oldpain &/or fever 3–7d61076RD −11 %−16% to −6%
unilateralpain &/or fever 3–7d6872RD −6%−12% to 0%
bilateralpain &/or fever 3–7d6456RD −20%−28% to −11%
< 2y old & bilateralpain &/or fever 3–7d6273RD −25%−36% to −14%
<2 y old & unilateralpain &/or fever 3–7d6261RD −5%−17% to 7%
≥2y old& bilateralpain &/or fever 3–7d6183RD −12%−25% to 1%
≥2y old & unilateralpain &/or fever 3–7d6611RD −7%−14% to 0%
otorrheapain &/or fever 3–7d6116RD −36%−53% to −19%
no otorrheapain &/or fever 3–7d6439RD −14%−23% to −5%
Spurling (2007)delayed ab vs imm abpain 3d1212OR 1.930.96 to 3.88
pain 4–6d1265OR 0.890.54 to 1.48
pain 7d1212OR 6.550.33 to 128.35
pain severity 3d1213WMD 0.750.26 to 1.24
pain severity 7d1212WMD 0.12−0.04 to 0.28
malaise 3d1285OR 2.621.44 to 4.76
malaise severity 3d1284WMD 0.43−0.11 to 0.75
malaise severity 7d1285WMD 0.690.31 to 1.07
fever 4–6d1265OR 0.880.53 to 1.47
Coleman (2008)decong/antihist vs none24persisting AOM 2wk122300OR 0.800.63 to 1.00
persisting AOM <7d2143OR 0.830.36 to 1.91
persisting AOM >2wk3378OR 1.390.69 to 2.80
otalgia2287OR 0.790.43 to 1.47
fever198OR 3.900.05 to 330.46
hearing loss2976OR 1.450.58 to 3.61
drowsy2567OR 8.680.53 to 143.30
hyperactivity3251OR 0.790.10 to 5.94
other side effect3416OR 5.001.73 to 14.48
prolonged OM 8–12wk1106OR 0.830.25 to 2.74
recurrent AOM <2wk5997OR 0.950.57 to 1.57
required surgery41172OR 1.280.67 to 2.46
mastoiditis or meningitis2662OR not estimablenot estimable

ab = antibiotic; abnl=abnormal; amox-clay=amoxicillin-clavulanate; amp/amox=ampicillin or amoxicillin; azith=azithromycin; CI=confidence interval; ery=erythromycin; GI=gastrointestinal; imm=immediate; OM=otitis media; OR= odds ratio; pcn= penicillin; RD=rate difference; RR=relative risk; ssx=sulfisoxazole; TM=tympanic membrane; TMP-SMX= trimethoprim-sulfamethoxazole; top= topical; WMD-weighted mean difference

17

Sensitivity analyses deleting or including problematic articles were also reported but are not listed in this table.

18

Sensitivity analysis by AOM diagnostic specificity was also reported but is not listed in this table.

19

Subgroup analyses by quality and sensitivity analyses excluding trials comparing different antibiotics were also reported but are not listed in this table.

20

Results for analyses comparing topical anaesthetic and naturopathic drops were also reported but apparently the studies showed significant heterogeneity and are not included in this table.

21

Measuring 50% pain reduction at 10, 20, and 30 minutes showed no difference.

22

individual patient data meta-analyses

23

Results of analyses for pain alone at 3–7 days with subgroup analyses and fever alone at 3–7 days without subgroups analyses were also reported but are not included in this table.

24

Analyses for decongestant and antihistamine alone and for decongestant and antihistamine together as well as subgroup analyses by primary outcome by various quality criteria, route of medication, and method to diagnose AOM resolution were also reported but are not included in this table.

From: Appendix I, Summaries of Systematic Reviews Included in Analyses

Cover of Management of Acute Otitis Media: Update
Management of Acute Otitis Media: Update.
Evidence Reports/Technology Assessments, No. 198.
Shekelle PG, Takata G, Newberry SJ, et al.

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