According to this POEM – there is no difference between Azithomycin and Amox-Clav in the treatment of otitis media.
Bottom line
For every 10 children with persistent or recurrent otitis media who get high-dose azithromycin for 3 days instead of high-dose amoxicillin-clavulanate for 10 days, there is one additional clinical cure at 1 month and 1 less episode of diarrhea. There is no difference, however, in clinical success at 2 weeks. (LOE = 1b)
But where's the placebo group? The study referenced above
A reminder that Chris Cates' EBM website has excellent resources on otitis media.
It's odd – because I do recall seeing many cases of recurent otitis when I was in residency – and even when I was at the Albany Medical Center residency program – where I was on the faculty. But in my current practice, my colleagues and I are so conservative with antibiotics that we rarely treat kids who present initially. We're seeing fewer cases overall – and fewer cases of resistant otitis and VERY few cases of recurrent otitis. I can't think of the last kid I referred to ENT.
Questions for the literature:
- Do delayed prescriptions reduce antibiotic prescriptions? Yes
- Is there a way to clinically predict which organism is causing an episode of otitis? YES (cool!) (viruses?)
- Why does AOM cause persistent OME?
- Are there well established international guidelines? No
