Systematic reviewindependent cross-checkabstract only checked★ key study I-ABX-09 in-depth review

Antibiotics for children's ear infections (Cochrane 2023)

Antibiotics for acute otitis media in children.

Overview

Venekamp RP et al.. Cochrane Database Syst Rev 2023 · PMID 37965923 · DOI 10.1002/14651858.CD000219.pub5

Antibiotics helped only a little with pain and caused side effects; serious complications were rare either way.

Does the study support the specific claim? Partly · Methodological quality: high

Study explained simply

What did the researchers want to find out?: Assess antibiotics in AOM.
How was the study done?: Cochrane review.
How many people, animals or samples were studied?: 13 RCTs.
What was actually found?: Small benefit, some harm.
How large was the observed effect?: NNTB 20, NNTH 14.
What do the results mean in everyday life?: Many ear infections heal alone.
What are the study's limitations?: High-income only.
What does it say about Elawady's specific claim?: Supports 'often unnecessary', not 'never'.
Do the results apply to Germany and Europe?: High.
What can explicitly not be concluded from this study?: Serious infections.

Authors: Venekamp RP et al.
Journal: Cochrane Database Syst Rev
Year: 2023
Identifier: PMID 37965923 DOI 10.1002/14651858.CD000219.pub5
Verification: verified – PubMed efetch 2026-10-25
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: Maroeska M Rovers has participated in workshops and educational activities on otitis media organised by GlaxoSmithKline and received a grant from GlaxoSmithKline for a study on the microbiology of otitis media in 2009. Roderick P Venekamp is an Editor for Cochrane Acute Respiratory Infections and Cochrane ENT. Sharon L Sanders declares no conflicts of interests in the current work. Paul P Glasziou is a co‐investigator on a NHMRC‐funded grant Antibiotic Resistance.

Effects of antibiotics for acute otitis media in children

Study design: Systematic review – Cochrane systematic review of RCTs (GRADE)
Population: Children with AOM
Country: High-income countries
Period: search to Feb 2023
Sample size: 13 placebo trials (3401 children); 6 trials vs expectant observation (1556)
Inclusion and exclusion criteria: RCTs

Results: Pain 24 h RR 0.89 (0.78-1.01); 2-3 days RR 0.71 (0.58-0.88), NNTB 20; adverse events RR 1.38 (1.16-1.63), NNTH 14; perforation RR 0.43, NNTB 33; contralateral otitis RR 0.49; severe complications rare and not different.
Absolute risks: NNTB 20 (pain at 2-3 days); NNTH 14 (adverse events).
Authors' conclusion: Modest benefits weighed against adverse effects (stated per outcomes in abstract).

Partly supports C-ABX-12's kernel (many mild infections do not need antibiotics).

High.

Shows antibiotics are often not needed for mild AOM - supports stewardship, not abstention in serious infection.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	high
Risk of bias	low
Precision of results	high
Directness	direct
Reproducibility	replicated
Consistency with the overall evidence	consistent
Regional transferability	high
Adequacy of the interpretation (by the archive)	not applicable

Low-income settings.