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The last time I wrote about acute otitis media in children I confessed shamefacedly that I still generally prescribed antibiotics, partly for lack of the lidocaine drops which an Australian study proved were effective for symptom relief (Bolt P, Barnett P, Babl FE, Sharwood LN. Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Arch Dis Child. 2008;93:40–44). For two decades, Calvinists from Scotland, Switzerland and the Netherlands have belaboured us on the sinfulness of treating this painful but generally self-limiting condition with antimicrobials; but those of us with weaker characters still needed something to offer desperate parents in place of the analgesics which they had already tried. And besides, their studies were generally not very good. Now along come two really good randomised controlled trials which show that co-amoxiclav reduces symptoms and improves resolution of OM – especially the latter, by otoscopic criteria. This first one was done in babies and toddlers in Pittsburgh.
NEJM 13 Jan 2011 Vol 364 p105
A very similar trial was also carried out in Turku, Finland, with the same intervention (amoxicillin-clavulanate) and results which seem more emphatic because expressed as “treatment failure” – 18.6% in the active group and 44.9% in the placebo group. The editorial on p.168, “Is Acute Otitis Media a Treatable Disease?” gives a lively historical overview which in essence validates what most of us have been doing anyway.
NEJM 13 Jan 2011 Vol 364 p116