Otitis media is in the news again. This time, a group from the Netherlands has published a trial of amoxicillin vs. placebo in kids under two. Until now, there had been little research on this population. The authors found no long term differences between the groups, but the placebo group had more symptoms at day four than did the amoxicillin group (NNT=7). The authors conclude that prescription of antibiotics at the first visit is not justified, "provided close surveillance can be guaranteed." If you subscribe to Journal Watch, you can read a review of this paper in which the reviewer disagrees with this conclusion.
When I teach medical students about otitis media, I am often impressed with how over-confident they are in their knowledge of this "simple" topic. Yet this paper reminds us that even the topics we consider to be so straightforward are in fact very complex.
